The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1719-1726
Acceptance of Seasonal Influenza Vaccination by Healthcare
Workers in Security Forced Hospital, Riyadh, Saudi Arabia
Meshari Zayed Almutari1, Abdulmajeed Mualla M Alotaibi2, Abdullah Mohammad Alluhaidan1,
Yazid Saad Alotaibi1, Ryan Mohammed Alamri1, Mohamed Saud Alshamari3,
Turki Khalid Alotaibi4, Nora Talal Alnashri5
1Imam Mohammad bin Saud University, 2Gdansk Medical University, 3King Saud bin Abdulaziz
University for Health Sciences, 4King Saud University, 5Royal College of Surgeons Ireland (RCSI)
*Corresponding author: Meshari Zayed Almutairi - Mr.email@example.com , Tel: +966564001088
Background: influenza is a major respiratory tract infection that can cause substantial morbidity and mortality.
The World Health Organization (WHO), United States (US) Center for Disease Control and Prevention (CDC)
and the immunization guidelines set by many countries including Saudi Arabia recommended the influenza
vaccination of healthcare workers (HCWs).
Objectives: to estimate the influenza vaccination rate among HCWs in Security Forced Hospital and to study the
effect of the HCWs' beliefs about influenza vaccine and influenza disease on acceptance of influenza vaccine by
HCWs in Security Forced Hospital.
Methods: the study is a retrospective study conducted in Security Forced Hospital between September and
December 2017. Data were collected using a self-administrated well-structured questionnaire to get the relevant
data needed in our study.
Results: out of the 249 participants, 126 (50.6%) have received the influenza vaccine. Most of our participants
were Saudi (70.3%), married (70.7%) and Muslims (78.3%). While, 33% of them were degree holder, 36.5%
were university students and 30.5% were having less education level. The income of most of the participants
(36.1%) was more than 15000 SAR per month.
Conclusion: the vaccination against influenza plays an important role in prevention of infection.Further studies
with lager population in different societies are recommended.
Keywords: Seasonal Influenza, Vaccination, Healthcare Workers.
Annually about 9% of the world's population
Influenza is a major respiratory tract infection
are affected by influenza . In Saudi Arabia during
that can cause substantial morbidity and mortality
the pilgrimage season there is a high risk for
(1).Influenza caused by influenza virus types A, B or C
transmission of influenza infection posing major
. Influenza type A is considered the most severe
threat to the health of airport personnel, healthcare
type of influenza. H1N1, a typeA virus, was the first
staff, security personnel and civilians. Hence Saudi
influenza virus recovered (1933) and was responsible
for the recent influenza pandemic .
recommending adoption of strict vaccination
Influenza infections among hospitalized
patients can have much more serious consequences
The WHO(9) and the CDC(10) have endorsed
than among the general population because an
the promotion of the flu vaccine. The WHO has
increasing proportion of hospital patients are elderly
aggressively campaigned for the importance of the flu
and immunocompromised .Influenza vaccination is
vaccine program both nationally and internationally.
universally recognized as the essential intervention to
Further, they declared that the seasonal flu vaccine is
limit the spread of the virus particularly among
safe, and the most effective in the protection against
elderly and patients with comorbidities . The World
the flu and avoidance of severe complications that
Health Organization (WHO), United States (US)
result in hospitalization.
Center for Disease Control and Prevention (CDC) and
There are many studies at the local and global
the immunization guidelines set by many countries
level that are interested in studying awareness and
including Saudi Arabia recommended the influenza
knowledge of influenza vaccine [11-15].The current
vaccination of healthcare workers (HCWs) .
study aimed to investigate the influenzavaccination
rate among HCWs in Security Forced Hospital and to
Received: 19/12/2017 DOI: 10.12816/0044741
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1627-1630
Prospective Study of Intraoperative Intrauterine Contraceptive
Device Application during Cesarean Section
Emad A. Rahman EL Tmamy *, Ahmed T. Abd ELfttah *, Mohamed I. ELmohandes, **, Amr Mohamed **
*Department of Obstetrics and Gynecology,Faculty of Medicine, Al-Azhar University, Cairo.
**Department of Obstetrics and Gynecology, El-Galaa Maternity Teaching Hospital, Cairo.
Background: intrauterine contraceptive device (IUCD) is the most widely used method of reversible fertility
regulation in the world. Over 100 million women worldwide use it for contraception. Many cultures have
addressed the need for successful fertility regulation by embracing and expanding IUCD. IUCD is one of the
most popular methods of contraception in Europe and Latin America, ranging from 10% to 30% of women
contraception. In Cuba, Egypt, and North Korea, IUCD use accounts for more than 50% of contraceptive use. In
China, 83% of married women used contraception and 36% of these women used IUCDs.
Patients and methods: this prospective study was conducted at Al-Galaa Maternity Teaching Hospital, dated
from 20/7/2016 to 20/1/2017, where 100 pregnant women attending the antenatal clinic were included according
to special criteria. Results: according to our results, the PPIUCD was demonstrably safe, having no reported
incidence of perforation, pregnancy with low rates of expulsion, pain abdomen, pelvic infection and lost strings.
Continuation rate in intra-cesarean insertion was higher compared to vaginal insertion. Conclusion: routinely
offering insertion of IUC at the time of elective cesarean section was popular among women. In addition, this
study confirmed the low complication rate associated with insertion of IUCD at this time and an expulsion rate in
keeping with that of insertion of IUC in women who are not postpartum
Keywords: prospective study, intrauterine , contraceptive, device , cesarian section.
Each year, more than 100 million women make
abdominal cavity in the case of rupture of the uterus
decisions about beginning contraception after child
or in the case of an abdominal pregnancy (4).
birth. Proper family planning programs and adequate
methods of contraception are important tools to avoid
PATIENT AND METHODS
many problems in our world (1).
ed at Al-Galaa
Contraception, socially recognized and accepted
Maternity Teaching Hospital, dated from 20/7/2016
only in the last 30 years, is both an essential and a
to 20/1/2017, where 100 pregnant women attending
complicated part of modern life. Contraception has
the antenatal clinic was included according to the
separated sextab from procreation and has provided
couples greater control and enjoyment of their lives.
It is a critical element in limiting population, thus
preserving our planet's resources and maintaining
Full term pregnant female without any medical
quality of life for ourselves and our children.
Contraception is both personal and a social
Planned for cesarean section.
responsibility. This could not be achieved by the
simple contraceptive methods employed before the
Normal findings evidenced by ultrasound scanning as
late 20th century. Greater effectiveness and ease of use
regard: gestational age, uterine cavity and placental
required more complicated methods, associated with
site (should be away from the scar).
Intrauterine Contraception (IUC) is the most widely
No congenital uterine anomalies.
used reversible method of fertility regulation in the
world. Over 100 million women worldwide use it for
Previous failed IUCD.
Cesarean delivery is defined as the birth of a fetus
Rupture membrane for more than 12 hours.
through incisions in the abdominal wall (laparotomy)
Absolute contraindication of IUD e.g.:
and the uterine wall (hysterotomy). This definition
History of ectopic pregnancy.
does not include removal of the fetus from the
Received: 17/10/2017 DOI: 10.12816/0044742
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1731-1736
Open Vs Laparoscopic Splenectomy among Saudi Patients
Ghadah Abdulsalam Aljoufi1, Amnah Hassan Mansour Alsaffar2, Ali Shuja Almatrafi3,
Sofanah Ahmad Alkosui4, Abdulaziz Mashuj Alanazi5, Abdulrahman Mohammed alzuwayed6,
Fahad Matouq Alkhuzaei7, Ahmed Abdullah AlGhamdi8, Abdullah mohammed Bafarat9, Sultan
Tareq Talab9, Mohammed Hamdan Alwabisi9, Yousef Ahmed H AlEsaeed10, Abdullah Mansour
Alharthi11, Sulaiman Ahmed Alhirbish6, Wafa Saleh Alkhuzaie12, Demah Hamoud Alayadhi13
1 Princess Nourah bint Abdulrahman Universty, 2Maternity and Children Hospital-Dammam, 3 Umm
alqura University, 4 Batterjee Medical College, 5 King Saud University, 6 Imam Abdulrahman Bin Faisal
University, 7 King Faisal Hospital, 8 Alnaser Primary Health Care Center - Al Madinah, 9 King Abdulaziz
University, 10 Gdansk Medical University, 11 King Abdulaziz Medical City for National Guard Jeddah,
12 Ibn Sina National College, KSA, 13 King Saud bin Abdulaziz University for Health Sciences
Corresponding Author: Ghadah Abdulsalam Aljoufi - Ghadah.firstname.lastname@example.org - 0568588226
The spleen is one of the most frequently injured intraperitoneal organs, and management of splenic injuries
may require splenectomy. Traditionally, surgical removal of the spleen was done by an open approach using
either an upper midline or left subcostal incision. Open splenectomy is performed in two major clinical
scenarios: trauma and hematologic disease. With the advent of minimally invasive techniques, laparoscopic
splenectomy has become a standard procedure for elective removal of the spleen for most
indications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant
diseases of the spleen. However, some contraindications still apply. The evolution of the technology has
allowed though, cases which were considered to be absolute contraindications for performing a minimal
invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of
advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic
splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased
experience of surgeons allows operative times comparable to those of an open splenectomy. In this review
we discussed the indications and the contraindications of laparoscopic splenectomy. Furthermore, we
analyze the surgical techniques.
Keywords: Spleen, Laparoscopic Splenectomy, Open Splenectomy, Technique.
The spleen is one of the most regularly injured
tuftsin). The present tendencies are toward
intraperitoneal organs, and management of splenic
nonoperative treatment of the spleen after trauma 
and toward laparoscopic splenectomy for
Conventionally, surgical removal of the spleen was
hematologic disorders . Nowadays, furthermost
completed by an open approach utilizing either an
upper midline or left subcostal incision. Open
laparoscopically, excluding the case of severe
splenectomy is performed in two major clinical
scenarios: trauma and hematologic disease. The
Even in the setting of massive splenomegaly,
spleen is a wedge-shaped organ that lies in relation
there is some indication to recommend that the
to the ninth and eleventh ribs, positioned in the left
laparoscopic method is safe and feasible in
hypochondrium and partially in the epigastrium;
children . With the advent of minimally invasive
accordingly, it is situated amid the fundus of the
techniques, laparoscopic splenectomy has become
stomach and the diaphragm. The spleen is
a standard procedure for elective removal of the
extremely vascular and reddish purple; its size and
spleen for most indications. Since the first report
weight are variable. A normal spleen is not
of laparoscopic splenectomy by Delaitre and
palpable. The spleen's key function is the removal
Maignien in 1991 , it has been increasingly used;
of old red blood cells (RBCs), defective circulating
however, several technical challenges remain
cells, and circulating bacteria. Furthermore, the
related to removing this fragile, well-vascularized
spleen supports preserve normal erythrocyte
organ that lies close to the stomach, colon,
morphology by processing immature erythrocytes,
pancreas, and kidney.
removing their nuclei, and changing the shape of
the cellular membrane. Further functions of the
MATERIALS AND METHODS
spleen contain the removal of nuclear remnants of
· Data Sources and Search terms
RBCs, denatured hemoglobin, and iron granules
We conducted this review using a comprehensive
and the manufacture of opsonins (properdin and
search of MEDLINE, PubMed, EMBASE,
Received: 18/12/2017 DOI: 10.12816/0044743
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1737-1741
Evaluation of Knowledge, Practice and Preventive Measures of
Hepatitis B Virus Among Dentists and Dental Auxiliaries Working at
Private Clinics in Qassim Province Saudi Arabia
Ahmad Saud Almutairi1, Abdullah Alfaris1, Abdulaziz Sulaiman Alkhodair2, Abdalmajeed
Alothaimeen1, Bader Abdulaziz Alzaben1
1 Dentist, Faculty of Dentistry, Al-Qassim University, Al-Qassim , Saudi Arabia.
1 Medical Intern, Faculty of Medicine, Al-Qassim University, Al-Qassim, Saudi Arabia.
Background: Hepatitis B virus (HBV) is a member of the family of the hepadna viridae, which is infectious
for humans and a few animal species. At the beginning of the third millennium, HBV remains a major
public health problem globally with more than one third of worlds' population infected. Of these, 350400
million suffer from chronic HBV infection. This infection has been identified as one of the most important
causes of liver failure and hepatocellular carcinoma (HCC). According to the world health organization
(WHO), more than 50 million cases of acute hepatitis B infection are reported annually with 510% of
adults and up to 90% of infants becoming chronically infected. From the dangers that face the dentist and
auxiliary dentist is infection transmission. This study was performed to search about the knowledge of viral
hepatitis and ways to prevent transmission and protect the dentists from viral hepatitis.
Methods: We conducted a descriptive cross-sectional study on dentists and dental auxiliaries working in
private dental clinics in Al-Qassim city, Saudi Arabia. The total sample obtained was 98 dentists and dental
Results: Nearly (36.3%) aged from 25-30 years old, (31.6%) aged from 31-35 years old, (22.4%) aged from
20-24 years old, and (9.2%) above 35 years old. The majority were dental hygienists and dental graduates,
(46.9%) and (40.8%), respectively. Almost the majority of participants (99%) had at least some knowledge
about viral hepatitis. (52%) thought hepatitis B vaccine can be given as post-exposure prophylaxis.
Conclusion: In conclusion, we need to emphasize on the preventive measures of transmission of viral
hepatitis among dentistry clinical field doctors.
Keywords: practice, knowledge, dentists, hepatitis.
Hepatitis B virus (HBV) is a member of the
to the hepatitis B virus and include tiredness,
family of the hepadna viridae, which is infectious
fever, and general aches, loss of appetite, feeling of
for humans and a few animal species(1). At the
being sick , diarrhea, abdominal pain and
beginning of the third millennium, HBV remains a
jaundice(6). Three doses of vaccine are generally
major public health problem globally with more
required to complete the hepatitis B vaccine
than one third of worlds' population infected (2,3).Of
series, the first dose can be taken any time, the
these, 350400 million suffer from chronic HBV
second dose at least one month after the first shot
infection(4,5). This infection has been identified as
and third dose after six month from first shot(8).
one of the most important causes of liver failure
Health care workers (HCWs) are at high risk of
and hepatocellular carcinoma (HCC) (4). According
HBV infection in the health care settings. The
to the world health organization (WHO), more than
prevalence rate of HBV in HCWs is about 210
50 million cases of acute hepatitis B infection are
times higher than the general populations in the
reported annually with 510% of adults and up to
world(9,10). The present study was conducted to
90% of infants becoming chronically infected(6).
explore the knowledge and practices of dentists and
With 500 000 to 1.2 million deaths per year caused
dental auxiliaries who are working in private
by chronic hepatitis, cirrhosis and HCC, the virus is
clinics in Qassim province Saudi Arabia about
the tenth cause of death globally(6). Hepatitis B
hepatitis B, as no such study has been previously
virus can be transmitted parentally, by
reported in the literature.
percutaneous route and through mucous membrane
exposed to infected blood, by sexual contact or by
perinatal exposure. Needles and syringes may be
We conducted a descriptive cross-sectional
contaminated by viruses. Accidental injuries with
study on dentists and dental auxiliaries working in
infected needles and syringes can transmit the virus
private dental clinics in Al-Qassim city, Saudi
to health care workers(7). The symptoms of hepatitis
Arabia. The total sample obtained was 98 dentists
B tend to occur two or three months after exposure
and dental auxiliaries. The study was conducted
Received: 5/12/2017 DOI: 10.12816/0044744
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1742-1744
Brucella Induced Thyroiditis: Case Report and Literature Review
Abrar N. Fatani1, Abdullah A. Alesa2*, Ahmed M. Alfaidi2, Rawia F. Albar3
1 King Abdulaziz University Jeddah, 2 King Saud bin Abdulaziz University for Health Science (KSAU-HS)
Jeddah, 3 Assistant consultant KSAU-HS, Consultant General Pediatrics and Pediatric Pulmonology
*Corresponding author: Abdullah A. Alesa, email:Alesa.email@example.com
Brucellosis is a zoonotic disease that can affect multiple organs and tissues in the human body with various
clinical presentations; however the thyroid gland is rarely involved. There are many species of Brucella, but
only a few can cause symptomatic infections to humans, with Brucella melitenses being the most common.
Here we report a case of Brucella induced thyroiditis which presented with pyrexia of unknown origin (PUO)
and a neck swelling. The patient had abnormal thyroid function test and a positive Brucella serum agglutination.
Early diagnosis and appropriate anti Brucella management showed great response and the patient fully
recovered. we hope to shed some light on this rare complication of Brucella infection through our study. We
have conducted a literature review of six cases that reported the same condition with some notable differences.
We believe that it is crucial to include brucellosis in the deferential diagnosis of any patient presenting PUO
especially when there is a positive history of unpasteurized dairy product consumption.
Keywords: Brucellosis, Thyroiditis, thyroid diseases.
cheese ingestion that was taken from a rural area
Brucellosis is a zoonotic disease that can affect
almost one month prior to her presentation. These
multiple organs and tissues in the human body with
symptoms were preceded by upper respiratory tract
various clinical presentations; however, the thyroid
infection (URTI) that was treated with Augmentin
gland is rarely involved. The gram negative
for 10 days. The fever was relieved by
bacteria are transmitted to humans by contaminated
acetaminophen for one hour and then spike up
animals through digestion, direct contact or
again. There was no dyspnea, cough, no lymph
inhalation. There are many species of Brucella, but
node enlargement, rash, arthralgia or diarrhea.
only a few can cause symptomatic infections to
Review of systems was unremarkable. Laboratory
humans. Brucella abortus, Brucella melitenses, are
investigations showed a hemoglobin of 10.4gm/dL,
the most common, while Brucella canis, and
normal WBC and platelets. She had elevated ESR
Brucella suis, are less frequently reported to cause
and CRP, with a value of 120mm/hr and 77.6mg/L,
the disease in humans (1). However, knowing the
respectively. Her thyroid function test revealed a
exact species will not affect the choice of therapy.
low TSH of 0.03 mlU/L and a high T4 level of
Patients might present with nonspecific symptoms,
21.2pmol/L, and was even higher when repeated
such as headache, fever, weight loss, and they
two days later, reaching to 27.6 pmol/L.
Her Brucella serology by enzyme linked
hepatosplenomegaly as physical signs. They also
immunosorbent assay(ELISA) was negative, even
might develop some serious complications such as
when repeated three weeks later. Chest X-ray and
meningitis and osteomyelitis (2). The definitive
CT were normal, but thyroid uptake scan showed
diagnosis of brucellosis is based on serology and
moderate reduced blood flow and significant
culture or both. Here we report a case of Brucella
diffuse suppressed thyroid function, giving the
induced thyroiditis and a literature review of six
impression of subacute thyroiditis. Blood and urine
cases that reported the same condition.
culture were all negative. Brucella serum
agglutination titer was done and showed a positive
result of 1:160, and accordingly the patient was
Fifty three years old female patient known case
of diabetes mellitus and gastroesophageal reflux
Doxycycline was stopped after two days as the
disease, on medications, presented with fever and
patient developed severe esophageal pain and
sore throat for the last two weeks. She was admitted
changed to Ciprofloxacin plus Rifampicin. The
as a case of pyrexia of unknown origin for
patient was discharged after two weeks from the
investigation. Documented fever at first day was
time of admission. She was afebrile for the last two
38.8°C and spiking up to 39.5°C in her first three
days and planned for six weeks of Ciprofloxacin
days of admission. The patient complained of
and Rifampicin. Two months after discharge, the
frontal headache, left neck pain and swelling,
patient recovered completely and all her laboratory
associated with fatigue, palpitations and decreased
workup including the thyroid function returned to
oral intake. She also gave a positive history of
Received: 20/12/2017 DOI: 10.12816/0044745
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1745-1747
Fungal Cerebellar Abscess in an Immunocompetent Patient
Muath A Gadouri1, Saja A. Shafei2, Tariq A. Madani3
1Faculty of Medicine, King Abdulaziz University, Jeddah, 2Department of Medicine,
King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Corresponding author: Muath Ahmad Gadouri, Mobile number: 0568889693, Email: firstname.lastname@example.org
Objective: We aimed to describe a case of fungal cerebellar abscesses due to Aspergillus in an
Methods: This was a case report of a patient who presented at King Abdulaziz University Hospital for
management of fungal cerebellar abscess.
Results: A 27-year-old Saudi patient presented with signs of cerebellar dysfunction, reduced visual acuity
outcome, and hoarseness following medical therapy and neurosurgery for cerebellar aspergillosis. Brain
computed tomography and magnetic resonance imaging scans revealed findings that were suggestive of a
recurrent or residual abscess. Treatment was initiated with oral corticosteroids and liposomal amphotericin B.
Two weeks later, liposomal amphotericin B was substituted for oral voriconazole. An initially planned surgical
excision was deferred following the improvement of the patient's symptoms.
Conclusion: Fungal cerebellar abscesses due to Aspergillus are extremely rare, especially in immunocompetent
patients. A high index of suspicion coupled with aggressive neurosurgical intervention and medical treatment can
lead to a favorable outcome in patients with cerebellar abscesses due to Aspergillus.
Keywords: Fungal, Cerebellar, Abscess, Immunocompetent, Patient.
Intracranial abscesses are uncommon, severe
immunocompromized 12-year-old girl.(6) We report
infections that can result in a fatal outcome if
a case of Aspergillus cerebellar abscess in an
diagnosis or treatment is delayed. Globally, the
immunocompetent young male patient.
incidence of the intracranial abscess is approximately
0.40.9 per 100,000 population, with higher rates
documented in immunocompromised patients;
A 27-year-old Saudi male presented to our
however, it can occur in patients of any age,
clinics for the management of a cerebellar abscess
including newborn infants (1) . About 70% of patients
due to Aspergillus that was treated surgically and
with intracranial abscesses are male, aged 34 years
medically at another hospital. The patient had a five-
on average(2). The etiologic agent may be any
month history of hypertension for which no medical
microorganism that can cause infection, including
treatment was warranted. His history was also
bacteria, fungi, protozoa, or helminths(1) .
remarkable for the following:
The focus of infection can arise anywhere but usually
Tinnitus of a few months' duration, which was
from infection of contiguous structures, such as otitis
later followed by a headache. He received
media, mastoiditis, or sinusitis, and spread to the
treatment for approximately one month, but his
brain through the bloodstream. In some cases, the
condition deteriorated with new-onset gait
infection is secondary to cranial trauma or surgery,
and, rarely, after meningitis. The source of infection
Brain computed tomography (CT) scan showed a
is unidentified in about 15% of patients with brain
cerebellar mass, and the patient was started on
steroid treatment, which was administered for one
Fungal cerebellar abscesses due to Aspergillus are
extremely rare, with an isolated number of cases
Brain magnetic resonance imaging (MRI) also
reported during the last half decade (4-6). In two of the
confirmed the cerebellar mass in addition to a chest
cases, the patients were immunocompetent: one was
the case of a middle-aged woman (4) while the other
A biopsy specimen was obtained from the mass,
was the case of a male neonate (5).The third was a
and a tissue culture revealed Aspergillus fumigatus
fatal case of Aspergillus abscess in an
Received: 17/12/2017 DOI: 10.12816/0044746
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1748-1751
Acute Lower Limb Deep Venous Thrombosis Diagnosed by
Doppler Ultrasound among Bedridden Patients
Fares Abdullah Alaskar1, Fahad Khalid Albahili2, Malik Azhar Hussain3, Basel Waleed Khurfan4
1Medical Imaging Department, King Fahad Medical City, Riyadh, 2Family Medicine Resident, Primary Health
care center, Riyadh, 3 Assistant Professor of Surgery, Northern Border University, Arar KSA, 4Surgery
Department, Specialized Medical Center, Riyadh, KSA
Background: Acute lower limb deep venous thrombosis (DVT) is a serious condition that could lead to venous
thromboembolism (VTE). Up to our knowledge, little is known about the risk factors for developing acute lower
limb DVT in bedridden patients across Saudi Arabia. So we conducted this study aiming to determine the
incidence and medical conditions that increase the risk for developing acute lower limb DVT in suspected cases
of bedridden patients admitted in or referred to Radiology Department, King Abdul-Aziz University Hospital for
lower limb Doppler ultrasound examination. Method: A cross sectional study of 83 patients admitted in or
referred to KAU hospital during the year 2016 and underwent lower limb Doppler examination. Result: The
reported incidence of lower limb DVT, after undergoing lower limb Doppler examination, in the suspected cases
reviewed by Radiology Department, King Abdul-Aziz University Hospital in Jeddah was 13 (15.7%). The cases
of DVT was 76.9% women. Elderly was the highest risk factor of acute limb DVT as 53.8% were elderly
patients, followed by diabetes 30.8%, hypertension 15.4% and cancer 7.7%, The effect of the studied risk factors
on DVT was insignificant (P value >0.05). Conclusion & recommendations: Lower Limb DVT has high
prevalence (15.7%) in bedridden patients in Jeddah, KSA. Thrombophilia screening should be reserved for
elderly, diabetics, hypertensive, and those with cancers or patients with other risk factors. Knowing the most
common risk factors and their significance in developing DVT is essential for early detection of DVT to prevent
the unwanted complications.
Keywords: Acute Lower limb DVT, Doppler Ultrasound, Cross Sectional Study.
compression methods improve blood flow.
Deep vein thrombosis (DVT) and pulmonary
Anticoagulation, which increases the risk of
embolism (PE) are responsible for significant
bleeding, might be used in high-risk scenarios . It
morbidity and mortality in hospitalized patients,
is estimated that 20 million cases of lower extremity
especially after surgery . The National Institutes of
DVT occur in the USA alone . Routine
Health Consensus Conference estimated that as
postoperative venography has shown an incidence of
many as 50000 people die annually from PE in the
60% in patients undergoing orthopedic surgery . A
USA, and 450 000 hospitalizations each year are
study was conducted in King Abdul Aziz hospital,
associated with DVT .
KSA found that total of 75 patients were diagnosed
Several medical conditions increase the
to have deep vein thrombosis with mean age of
risk for DVT, including cancer, trauma, and
44.16 + 14.5 years and male: female ratio of 1:2.
antiphospholipid syndrome. Other risk factors
Doppler ultrasound was used for the diagnosis in
include older age, surgery, immobilization (as with
75% patients. Pulmonary embolism as a
bed rest, orthopedic casts, and sitting on long
complication of deep vein thrombosis developed in
flights), combined oral contraceptives, pregnancy,
32% of patients. Prolonged immobilization was
the postnatal period, and genetic factors. Those
found to be the most common risk factor (23%) .
genetic factors include deficiencies with anti-
Another study in India showed that acute DVT
thrombin, protein C, and protein S, the mutation of
without PE, acute DVT with PE, and PE alone were
factor V Leiden, and the property of having a non-O
reported in 64%, 23%, and 13% of patients,
blood type . Multiple pharmacological therapies
respectively. Mean age was 47 (±16) years, and 70%
for DVT were introduced in the 20th century: oral
were males. Previous history of DVT (34%), surgery
anticoagulants in the 1940s, subcutaneous low-dose
including orthopedic surgery (28%), trauma (16%),
unfractionated heparin (LDUH) in 1962 and
and immobilization >3 days (14%) were the most
subcutaneous low molecular weight heparin
common risk factors for VTE. Hypertension (25%),
(LMWH) in 1982 . Depending upon the risk for
diabetes (19%), and neurological disease (other than
stroke) (8%) were the most common. The annual
recommended. Walking and calf exercises reduce
incidence of DVT (±PE) increased from 2006 to
venous stasis because leg muscle contractions
compress the veins and pump blood up towards the
Up to our knowledge, little is known about the
heart . In immobile individuals, physical
risk factors for developing acute lower limb DVT
Received: 20/12/2017 DOI: 10.12816/0044747
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1752-1760
Medical Students' Beliefs and Attitudes Towards Schizophrenia Before and
After Psychiatric Training in Almaarefa Colleges, Riyadh, Saudi Arabia
Dina Khaled Alhajri, Afnan Abdullah Alghamdi
Almaarefa Colleges, Riyadh, Saudi Arabia.
Background: Public surveys have shown that the general population has limited knowledge about mental
illness and holds unfavorable attitudes towards the people who suffer from it in various, culturally diverse,
Aims: The aim of the present study was to explore medical students beliefs and attitudes towards people
with schizophrenia (PwS) prior to receiving any training in psychiatry and to assess the impact of the
psychiatric placement on changing them.
Methods: A questionnaire addressing beliefs, attitudes and desired social distance from PwS was distributed
to all final year medical students before the beginning of their 4-week undergraduate psychiatric placement
and upon its completion.
Results: Students did not endorse stereotypes commonly attached to PwS, such as being dangerous, lazy or of
lower intelligence, but they held the view that PwS are unpredictable and suffer from split personality.
Furthermore, the baseline level of desired social distance was found to increase as the intimacy of the
interaction increased, and the only variable associated with it was personal experience of serious mental
illness. Moreover, the placement was found to have either no influence at all or in a negative direction. Upon
its completion more students were found to believe that PwS couldnt recover, have no insight into their
condition, cannot make reasonable decisions, cannot work in regular jobs and are dangerous to the public. No
difference was recorded in social distance scores.
Conclusions: A close and critical examination of the various elements of the undergraduate placement in
psychiatry is needed in order to develop an evidence based, fully rounded education with an anti-stigma
Keywords: attitudes, medical students, mental illness, schizophrenia, stigma
physical complaints were not taken seriously (8). In
The stigma and prejudice surrounding mental
addition, various studies have indicated that
illness exist widely throughout the world. Public
stigma and discrimination by physicians often lead
surveys have shown that the general population
to people with psychiatric disorders having less
has limited knowledge about mental illness and
access to primary care, (9) and receiving inferior
holds unfavorable attitudes towards the people
care for physical health problems, such as heart
who suffer from it in various, culturally diverse,
attacks, (10) despite the high rates of physical
countries. (1-3) Nonetheless, stigmatizing attitudes
illness and mortality among them (11,12). It is thus
to mental illness, and especially schizophrenia, the
imperative to develop effective strategies for
most representative of the psychiatric disorders in
improving physicians attitudes and practices
lay peoples minds, (4) are not limited to the
towards people with mental illness. One of the
general population but are also common among
strategies that have been proposed is that of
health professionals. Many surveys have shown
targeting medical students, who are considered
that medical doctors endorse stereotypical views
,,tomorrows doctors (13). A cohort study in
and negative attitudes towards patients with
England demonstrated that while 28% of medical
psychiatric disorders. (5,6) This finding has also
students reported that people with psychiatric
been validated by first-person accounts of people
disorders are not ,,easy to like, 2 years later, when
with mental illness. Focus group studies have
students had become medical practitioners, the
found that when service users were asked about
rate increased to 56% (14).
their stigma experiences and about potential
Furthermore, a wealth of studies worldwide has
groups for targeted anti-stigma interventions,
shown that medical students hold rejecting and
family doctors were the group most often
distancing attitudes towards people with mental
illness (15-17). These negative misconceptions not
Service users reported that health-care
only impact on people with psychiatric disorders
providers treated them disrespectfully where they
and their families, they also damage the image of
had to wait longer than other patients and that their
psychiatry, because the majority of medical
Received: 18/12/2017 DOI: 10.12816/0044748
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1761-1766
Smoking and Vascular Disease
Dana Ibrahim Alabdalqadir1, Abdulmohsen Mohammed Aldrees2, Majed Hameed Madloul Sayah3,
Wedyan Abdullatif Alabdullatif4, Mona Ahmed Al Hamad5, Abduaziz Ayedh Ali Alghamdi6,
Heba Yousef Alfrayheen7, Abdulmohsn Ali Almajhad8, Abdullah Ahmad Alghamdy1,
Fatimah Ali Alomran3, Yazed Khalid Alkhader1, Sireen Yousef Bakhsh9, Mohammed Ali Dahas10,
Fady Shaker Saati11, Ayman Ahmed Almohammed12, Ali Hussain Aldraisi13
1 Arabian Gulf University, 2 Xinjiang Medical University-China, 3 Almaarefa Colleges,
4 Imam Abdulrahman Bin Faisal University, 5 Safwa General Hospital, 6 Albaha University,
7 Maternity and Children Hospital-Dammam, 8 Qassim University, 9 King Fahad General Hospital-Jeddah,
10 Primary Health Care Sabia, 11 East Jeddah Hospital,12 King Faisal University,
13 Hassan Alafaliq Hospital For Basic Care
Corresponding Author: Dana Ibrahim Alabdalqadir - Dana.Aq@Icloud.Com - 0568611388
Background: Smoking is considered a crucial predisposing factor for the development of carotid diseases,
cardiovascular disease, and peripheral artery disease. Around 10% of Americans have peripheral artery disease
that is most likely related to smoking, and smoking is strongly associated with abdominal aortic aneurysms. The
most important cause of death among smokers continues to be cardiovascular diseases.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE,
January 1985, through February 2017. The following search terms were used: smoking, cardiovascular diseases,
abdominal aortic aneurysms, peripheral vascular diseases, tobacco chemicals, smoking effects on blood vessels
Aim: In this review, we aim to study the pathophysiology and mechanism of adverse effects caused by cigarette
smoking upon the vascular system. Conclusion: Exposure to smoking both directly and indirectly is associated
with significant increase in strokes, coronary heart diseases, aneurysms, and peripheral artery diseases.
Atherosclerosis is also strongly associated with cigarette smoking. Smoking cessation will rapidly improve the
overall health status and decrease the risk of cardiovascular diseases. More studies are needed to evaluate and
assess mechanisms associated with smoking-related cardiovascular diseases.
Keywords: cardiovascular diseases, abdominal aortic aneurysms, peripheral vascular diseases, tobacco chemicals,
smoking as a culprit.
abdominal aortic aneurysm. Regarding costs, smoking
About 16% of adults in the United States are
causes large costs to health care system, and its
smokers with higher prevalence among men than
prevention will be associated with significant decrease
women. Moreover, up to 24% of school students are
in costs .
smokers. However, smoking rates have been
decreasing recently. Smoking is considered a crucial
predisposing factor for the development of carotid
· Data Sources and Search terms
diseases, cardiovascular disease, and peripheral artery
We conducted this review using a comprehensive
disease. Actually, about 10% of Americans have
search of MEDLINE, PubMed, and EMBASE,
peripheral artery disease that is most likely related to
January 1985, through February 2017. The following
smoking. Additionally, smoking is strongly associated
search terms were used: smoking, cardiovascular
with abdominal aortic aneurysms that can occur in up
diseases, abdominal aortic aneurysms, peripheral
to 7% of male smokers.
vascular diseases, tobacco chemicals, smoking effects
The most important cause of death among smokers
on blood vessels. The study was done after
continues to be cardiovascular diseases. About 7,357
approval of ethical board of Imam Abdulrahman
toxic chemical compounds have been documented to
Bin Faisal university.
be present in tobacco smoke, of which nicotine is the
most important. Smoking has been associated with
· Data Extraction
higher active cellular process that is suggested to play
Two reviewers have independently reviewed the
a role in the pathogenesis of atherosclerosis and
studies, abstracted data, and disagreements were
Received: 16/12/2017 DOI: 10.12816/0044749
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1767-1772
Efficacy of Laryngeal Mask Airway in Neonatal Resuscitation
Mohamed S. El-Shimi1, Ibrahim S. AbuSaif1, Soha M. Khafagy1,
Rania M. Mohamed2, Mohamed B. El-Ahmadi
Department of Pediatrics, Department of Anesthesia & Intensive Care, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
Corresponding Author: Mohamed B. El-Ahmadi,email: email@example.com
Aim: This study aimed at evaluating the use of LMA for resuscitation in the delivery room among newborn
infants whom positive pressure ventilation (PPV) by bag and mask had failed.
Materials and methods: This is a single center, prospective, unblinded, randomized clinical trial of LMA
ventilation versus ETT on neonates during resuscitation upon delivery at Ain Shams Maternity Hospital during
the period between January 2012 and January 2015. The Study included 80 newborns delivered in the Maternity
hospital, Ain Shams University with gestational age of 34 weeks or more who needed neonatal resuscitation in
the delivery room which was performed according to the current guidelines for neonatal resuscitation by the
American Academy of Pediatrics. Results: In Our Study, there was significant correlation between the LMA and
the ETT as both of them succeeded to achieve adequate ventilation of the resuscitated infants. Both groups
showed statistical significant improvement between their Oxygen saturation at 1 minute & at 5 minutes. The
ETT showed more improvement as the mean difference between 1 & 5 minutes was -27.4±3.07 compared to -
26.5±3.4 among the LMA, but with insignificant difference between both groups. Comparison between Apgar
score at 1 & 5 minutes in both groups is apparent, which showed statistical significant improvement in the 2
groups. However, the ETT group showed more improvement (although non-significant) as the mean difference
between 1 & 5 minutes was -5.02±0.9 compared to -4.6±0.7 among the LMA group.
Conclusion: The Laryngeal Mask Airway can be used as an efficient and successful alternative to endotracheal
intubation in newborns > 2000 Gms who require neonatal resuscitation.
Keywords: LMA, Neonatal Resuscitation, ETT, LMA.
bronchial perforation2. So we aimed at our study to
Difficult airway management in neonates and
evaluate the effectiveness of LMA compared to
young infants still remains a challenge, even for
endotracheal tube in resuscitation of newborn infants
well-trained pediatricians or anesthesiologists. This
who fail to respond to bag and mask ventilation.
holds true particularly when a difficult airway is
encountered unexpectedly, e.g. after induction of
PATIENTS AND METHODS
anesthesia or in respiratory emergencies. If mask
This is a single center, prospective, unblinded,
ventilation and/or direct laryngoscopy fails,
randomized clinical trial of LMA ventilation versus
supraglottic airway devices, i.e. pediatric-sized
ETT on neonates during resuscitation upon delivery
laryngeal masks (LMA), have been demonstrated to
at Ain Shams Maternity Hospital during the period
be a reliable rescue device1. The LMA is an airway
between January 2012 and January 2015.
device that is inserted through the mouth without
Ethics committee of Ain Shams University Hospital
instrumentation and forms a low-pressure seal
approved the study and a written informed consent
around the glottis rather than passing through the
was obtained from a parent by a member of the
glottis. It has been used as an effective and less
neonatal team involved in the study before delivery.
invasive alternative to endotracheal intubation
(ETT)2. Complications associated with ETT such as
The Study included 80 newborns delivered in the
Maternity hospital, Ain Shams University with
bronchospasm, drying of mucosa and effects on
gestational age of 34 weeks or more and who needed
mucociliary function, laryngospasm and acute
neonatal resuscitation in the delivery room which
traumatic complications as injury to the lips, teeth,
was performed according to the current guidelines
tongue, nose, pharynx, larynx, trachea and bronchi
for neonatal resuscitation by the American Academy
can occur during laryngoscopy and intubation. Also,
noxious autonomic reflexes as hypertension,
The studied patients were randomly assigned into 2
tachycardia, arrhythmias, intracranial and intraocular
groups:- Group A: included 40 newborns, who were
hypertension as well as esophageal, tracheal and
Received: 20/12/2017 DOI: 10.12816/0044750
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1773-1777
Risk Factors of Stroke among Young Adults in KSA
1Wejdan Nasser Al Maqbul, 1Amina Abdo Salhi, 2Sarah Naif Aldewish,3Sarrah Awad Alshammari,
1Maram Mohammed Al Yami ,2Ahmed Maashi Alanazi
1. Najran University, 2. Faculty of Medicine, Almaarefa College,
3. Faculty of Medicine, University of Halal, Saudi Arabia
*Corresponding author Wejdan Nasser AL Magbul, E-mail: Dr.jode20 @hotmail.com
Background: Current literature suggests that hospitalization rates kept increasing with time because stroke risk
factors such as high blood pressure, diabetes and obesity have been increasing in the general population.
Moreover, stroke is particularly devastating among young people because of its disabling effects, which can last a
lifetime. Stroke in young adults is often missed by less experienced clinicians due to its unexpectedness, leading
to lost opportunities for intervention. Aim of the study: was to assess the awareness of young adults in KSA of
the risk factors, signs and symptoms of stroke.
Methods: The present cross-sectional study enrolled 150 Saudi males and females who were randomly selected
during the period from October2017 to December 2017.. A self-report questionnaire was used to evaluate
STROKE awareness among participants while Statistical Package for Social Sciences (SPSS) method was used
for data analysis.
Results: Our study revealed that the majority of participants were able to relate stroke to the correct underlying
risk factors particularly obesity and smoking which score 85.3% and 84.0% respectively. Likewise, 75% agreed
that fatty food is a contributing risk factor for stroke while only 61% thought that diabetic patients are at a higher
chance for developing stroke. As for the signs of cerebral stroke, the majority of participants had basic knowledge
on the signs and symptoms of stroke such as hypertension (83%), face drop , difficulty speech and arm
Weakness(76%).In the meantime, Overall , an average of 13% of participants declared no knowledge across all
questions. Conclusions: Our study revealed improved yet still insufficient knowledge of brain stroke among the
study group of young Saudi females and males adults regardless to the age group since the majority of
participants were able to correlate stroke with the key predisposing risk factors as well as the signs of stroke. This
indicates that proper intervention was in place to spread the awareness of this crucial medical emergency.
However, this effort needs to continue to further improve knowledge about stroke, risk reduction, and appropriate
stroke response and prevention. Nevertheless, further studies should be conducted on a larger scale to make a
definite conclusion on the regression of stroke awareness in young adults population in Saudi Arabia.
Keywords: stroke, Intravenous thrombolysis, hypertension, Ischemic stroke, awareness, Saudi Arabia.
Stroke or cerebro-vascular accident (CVA)has
deficiency syndrome infection and cerebral
become one of the leading causes of serious, long-
malaria are increasingly being encountered in the
term neurologic impairment and functional disability
and is the cause of mortality globally (1).
According to the World Health Organization
It involves the rapid loss of brain function caused
(WHO), around 15 million people, all over the world
by a disruption of blood supply to the brain, which is
suffer from stroke each year (4).
usually triggered by ischemia (lack of blood flow) or
Stroke is being observed as a rapidly growing
blockage (thrombosis, arterial embolism) or a
problem and an important cause of illness and death
hemorrhage, However, there are no known drug
in Saudi Arabia. Therefore, it becomes one of the
therapies to improve recovery after stroke (1).
most imperative social and economic medical issues
Depending on the severity and type, stroke can leave
in the Kingdom (5). Yet compared to developing
an individual with a residual damage of physical,
countries, there is an obvious lack of research
psychological, social and cognitive functions (2).
available on the incidence and prevalence along with
The established risk factors, including arterial
the socio-demographic properties of stroke.
hypertension, diabetes mellitus, cigarette smoking,
The objective of the present study is to evaluate
micro-vascular rupture, hyperlipidemia, age and
and measure the knowledge of young adults about
observed comorbidity, such as sickle cell disease,
risk factor of stroke as well as their knowledge of the
human immunodeficiency virus/acquired immune
signs and symptoms of stroke.
Received: 20/12/2017 DOI: 10.12816/0044751
COMPARISON BETWEEN THE EFFICACY OF TRANSURETERAL LITHOTRIPSY AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN THE TREATMENT OF DISTAL URETERAL STONE
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1778-1783
Comparison between the Efficacy of Transureteral
Lithotripsy and Extracorporeal Shock Wave Lithotripsy in the
Treatment of Distal Ureteral Stone
Mahmoud Ezzat Ibrahim, Ahmed Tawfik Hasaan, Ahmed Mohamed Helmy
Department of Urology, Faculty of Medicine, Ain Shams University.
*Corresponding author: firstname.lastname@example.org
Objective: To compare the efficacy, cost effect and safety of extracorporeal shock wave lithotripsy (ESWL)
and ureteroscopy (URS) for distal ureteric calculi by evaluating stone-free rates, retreatment rates, need for
auxiliary procedures, associated complications and technical consideration with respect to patient satisfaction.
Patient and method: 70 patients with single unilateral radiopaque distal ureteric stone ranges from 0.8 cm to
1.2 cm in diameter and 1.5 cm in length were enrolled in a prospective randomized trial. Patients were
randomized to undergo URS (35) or ESWL (35). The electromagnetic Dornier lithotripter S was used for
ESWL and a semi-rigid Olympus ureteroscope, 7° direction of view, angled ocular,8.6/9.8 Fr. x 43 cm, 6.4 Fr.
channel was used for URS. Patient and stone characteristics, treatment parameters, clinical outcomes, and
patient satisfaction were assessed for each group. Results: Patients in the ESWL group achieved a 77.1%
overall stone-free rate (SFR) with a 74.3% retreatment rate and no auxiliary procedure was done.
Complications occurred in 11.4% of patients treated with ESWL. Patients in the URS group achieved a 97.1%
overall SFR with a retreatment rate of 8.6% and an auxiliary procedure rate of 100%. Complications occurred
in 31.4% of patients treated with URS. Patient satisfaction was high for both groups, including 94.3% for URS
and 77.1% for ESWL. ESWL were already at outpatient clinic so there were no admission or hospital stay.
While in URS group patients admitted with mean hospital stay 1.6±0.5 day.
Conclusions: In the treatment of large distal ureteral calculi 1.5 cm, both URS and ESWL modalities are
comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone-free
rate and it provides immediate stone clearance with lower retreatment rates and higher patient satisfaction.
Keywords: ureteral calculi; ureteroscopy; extracorporeal shockwave lithotripsy.
URS, localization of the stone might be difficult and
The lifetime prevalence of ureteric calculi is
being stone-free requires a longer time with higher
relatively high, occurring in approximately 12% of
retreatment rate (3). Most of studies also beside our
men and 7% of women. The risk is increased with a
study confirmed that URS has the annoyance of
past history of ureteric calculi and with positive
hospitalization, spinal anesthesia, and ureteral stent
family history. Most patients present between ages
removal; on the other hands, ESWL involves a
30 and 60, with peak incidence between ages 35-45
higher retreatment rate, long-term follow-up, and
(1). American Urology Association (AUA)/European
frequent visits. Moreover, patients may visit the
Association of Urology (EAU) Guidelines in
emergency room to control intolerable pain in the
Ureteral Stone Management, recommend URS as
course of the treatment. In our study, we compared
1st option and ESWL as 2nd option in treatment of
ureteroscopic intracorporeal pneumatic lithotripsy
distal ureteral stone greater than 1 cm, overall stone-
versus ESWL in treatment of large distal ureteral
free rates after URS or ESWL for distal ureteral
stone 1.5 cm by evaluating stone-free rates,
stones are comparable. However, larger stones
retreatment rates, cost effect, need for auxiliary
achieve earlier stone-free status with URS.
procedures, associated complications and technical
Although URS is effective for ureteric calculi, it has
consideration with respect to patient satisfaction.
greater potential for complications. However, in the
current endourological era, the complication rate
PATIENTS AND METHODS
and morbidity of ureteroscopy have been
This study was performed at Ain Shams
significantly reduced (2).Authors support URS claim
University (Urology Department) and El Doaah
that it is highly successful, associated with minimal
hospital (Urology Department), From August 2016
morbidity, other investigators argue that it requires
to August 2017. It is a prospective randomized
specialized training, more invasive, requires general
study that was performed on 70 patients having
or regional anesthesia, and often requires ureteral
radiopaque distal ureteric stone ranges between 0.8-
stent placement. Authors support ESWL claim that
1.2 cm in diameter and 1.5 cm in length. Stone
it is effective and non-invasive, is associated with
size was defined as the largest diameter measured
less morbidity, and can be done on an outpatient
on CT. Distal ureter was defined as the segment
basis with intravenous sedation. Other authors
between the lower border of the sacroiliac joint and
stated that success rates are not as high as those of
the ureterovesical junction. Both sexes are included,
Received: 20/12/2017 DOI: 10.12816/0044752
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1784-1788
Causes of Absenteeism Rate among Staff Nurses at Medina
Maternity and Child Hospital
FL. Alharbi1*, TB. Almuzini 2, AA. Aljohani2, KA. Aljohani2, AR. Albowini3,
ME. Aljohani4, MM. Althubyni5
Departments of Nursing and Pharmacy
1-Alsafiah Health Care, Medina, 2- King Fahd Hospital, Medina,3- Maternity and Child Hospital,
Medina, 4- Primary Health Care, Medina, 5- AL Madinah Specialist hospital, Medina, SA
*Corresponding author: FL. Alharbi, Mobile No.+966594263278, E-Mail: Fahdiah1331@gmail.com
Background: Multiple factors are associated with absenteeism among nursing staff around the world with
an increasing rate that affects the delivery of health care to patients and reflects non-satisfaction of the
nursing staff. Objectives: Evaluating the factors associated with high rates of absenteeism among staff nurse
in Medina Maternity and Child Hospital (MMCH).
Methods: This is a descriptive study that was conducted among a sample of 405 nurses working at MMCH.
The study tool included a questionnaire sheet of 2 parts as demographics and causes of absenteeism. All the
nurses were interviewed and asked to fill up the questionnaire sheet.
Results: Most of the included nurses had Diploma degree and about 5 years of experience (50.4%).
The majority of nurses had good knowledge about the effects of absenteeism on work performance. The
most common etiological factors associated with absenteeism were no overtime payment (75.6%) and social
reasons among 77.8 % of nurses.
Conclusion: The increasing rates of absenteeism among nursing staff working in MMCH were not founding
the payment for overtime work followed by social reasons for nurses. Thus, considering over-time and
working status as shift times and numbers of nurses per shift are important motivators that could decrease the
rates of absenteeism among nursing staff and increase the rates of nurses satisfaction to their jobs.
Keywords: Staff Nurses, Absenteeism, Rates, Medina, KSA.
overloaded when covering the absence of their
Absenteeism has many definitions including
absent colleagues, which might decrease their job
missing a day or many days of the work. Another
motivation and productivity and could differ from
definition could be unplanned absence without
one setting to another one in the same hospital (1,
excuse or warning (1, 2). It is a worldwide problem
9). This study examines the causes of absenteeism
with an exaggerated rates which could result in
among hospital nurses in Madinah, Saudi Arabia.
hindering the delivery of health care to patients
that associated with shortage of number of
available health staff (3). The absenteeism of
employee is Employee absenteeism which is a
A descriptive cross sectional study that was
remarkable issue that was found to affect the
conducted at medina maternity and child hospital,
productivity of all work sectors all over the world
Kingdom of Saudi Arabia (KSA). Study
(4). Many studies have been conducted to assess
the absence among health stuff members
A random sample of 405 nurses were included in
especially among nurses which was the focus of
the study from different departments from both
researchers showing that sickness is the most
genders. All the nurses were interviewed and
prevalent cause for absence (1) as well as job
asked to fill up a questionnaire sheet to assess the
satisfactions and turn overs (5).The absence of
causes of absenteeism.
nurses is significantly associated with burden of
health care settings which impose many costs for
health organizations (6).
The study tool was a structure interview sheet
Also, it could result in increasing the work
that included two parts. The first part included
load on other nurses as well as comprising the
questions related to the demographics of the
patients' health outcomes thus increase the
nurses including age, sex, education and marital
mortality rates (7, 8).
status. The second part of the sheet included a
The overload in work was a result of
questionnaire to assess the causes of absence. The
absenteeism among nurses that could decrease
questionnaire was approved by the supervisors
the motivation of the work. Nurses are often
after reviewing the available literature and studies
Received: 20/12/2017 DOI: 10.12816/0044753
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1789-1793
Beliefs on Influenza Disease and Vaccine among Health Care
Workers in Jeddah, Saudi Arabia
Khalid A Alghamdi 1, Adnan A Alshumrani1, Majed A Althagafi 2,
Saleh H Alzahrani 3, Mohammed A Althagfi 4
1Ibn Sina National College for Medical Studies,2Batterjee Medical College,
3Umm Al-Qura University,4King Abdulaziz University
Background: Seasonal influenza is considered to be a serious public health problem that may cause death in
high risk population. It is very important for healthcare workers who are in direct contact with patients to get
influenza-vaccinated. However most of the Middle East countries provide many vaccination programs to
healthcare workers against influenza virus, the current vaccination rates are very low. This highlight the need
to study the current knowledge and awareness about influenza vaccination in healthcare workers (HCWs) in
Middle East and specifically Saudi Arabia.
Objectives: The aim for this study was to assess beliefs and awareness level about influenza vaccine among
healthcare workers in Jeddah, Saudi Arabia.
Subjects and methods: A cross-control study was conducted using an anonymous web-based survey. A total
of 172 subjects from Jeddah, Saudi Arabia took part in this survey during the period from 6 January 2018 to 20
Results: The majority of the subjects were females (58.7%), Saudi (88.4%), Muslims (99.4%), single (62.8%)
with a mean (±SD) age of 27.28 ±8.39 years. 74.4% answered that their work is clinical. There was a
statistically significant correlation between the knowledge score and each of "marital status" (p=0.039),
"medical history" (p=0.032), "those intending to get vaccinated for the next season" (p=0.006). The highest
scores were reported among "single" subjects, subjects with no "medical history" and those who were
intending to get vaccinated for the next season.
Conclusion:Beliefs and awareness about influenza vaccination have very important effects on the rate of
seasonal influenza vaccine of health care workers. We recommend tailoring educational programs and
awareness campaigns in order to achieve better vaccination rates and decrease the risks associated with
influenza infections in Saudi Arabia.
Keywords: Influenza, Seasonal Influenza, Vaccination, Knowledge, Saudi Arabia.
According to European Centre for Disease
In World Health Organization fact sheet about
Prevention and Control (ECDPC), seasonal
seasonal influenza, it was recommended for
influenza causes 15,000-70,000 European deaths
pregnant women, children aged between 6 months
every year of causes associated with influenza1.
to 5 years, elderly individuals, individuals with
Although the duration of illness is usually short,
chronic medical conditions and healthcare workers
the yearly economic and healthcare burden of
to get a yearly influenza vaccination6.
influenza is major. Over the years, vaccination has
been the main master plan for both controlling and
MATERIALS AND METHODS
A meta-analysis conducted in 2011 to explore
This cross-sectional study was conducted using
the effectiveness of influenza vaccines revealed
an anonymous web-based questionnaire. A total of
that the vaccines provides moderate protection
172 healthcare workers from Jeddah, Saudi Arabia
against influenza. The vaccine continually shows
took part in this survey.
appropriate efficacy in children aged up to 7 years.
Participants were asked to fill an anonymous
However, there was no enough evidence of
protection among elderly individuals aged 65
characteristics, occupation, medical history and
influenza vaccination history in addition to other
It is very important for healthcare workers who
questions related to their knowledge in relation to
are in direct contact with patients to get influenza-
influenza vaccination. The study was conducted
vaccinated every year to protect them from getting
during the period from 6 January 2018 to 20
influenza and to reduce transmission of influenza
January 2018. Institutional review board approval
to whomever they are in contact with5.
Received: 20/12/2017 DOI: 10.12816/0044754
Psychological and Social Factors of Postpartum Depression
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1794-1800
Postpartum Depression among Saudi Women at National Guard
Hospital and Alyamama Hospital in Riyadh in 2014-2015
Wala Al-anazia Esra Al-amria Saja Al-hayana, Razan Al-Bibia Hawa Al-Shammaria ,
Munwah Al-Rushaydana, Reem Al-Munaysira, Sarah Al-Rumayha, Waad Al-Shehria
a Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia
*Corresponding author: Wala Rafa Alanazi, Email: Wala.email@example.com, Mobile number: +966506120311
Background: Postpartum Depression (PPD) is defined briefly as a "complication of birth where its reasons
are differing from a carrier mother to mother". Symptoms of PPD resemble those of any other depression
disorders but PPD is characterized by the time of occurrence and period than any other depression.
Objectives: This study aimed to estimate proportion of postpartum depression among Saudi women and
identify the social and psychological factors that related to postpartum depression.
Methods: The study included 150 postnatal females, selected randomly in (2014 -2015). The data collected
through structured questionnaires. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen
for PPD. Result: This study found that there was a strong statistical association between PPD and anxiety
regarding baby's expenses (38.2%), PPD and having still births or babies born with health issues (62.6%).
Also, in having PPD in a previous pregnancy (53.4%). In addition those who were having a history of
depression associated with PPD (47.2%). Lastly, anxiety regarding baby's responsibilities had a border line
association with PPD (69.9%). Also, we found that there was a strong associations between PPD and not
receiving support from family or friends during pregnancy (35%), or from husbands during pregnancy
(43.9%), not having husbands beside them during labor (55.3%), and not having a good marriage
Conclusion: PPD was associated with stillbirth, unhealthy baby, history of PPD depression, anxiety about
baby's responsibility or expenses, lack of support from family or husband and bad marriage.
Keyword: Postpartum depression- Depression- Psychological factors Baby blues
A birth of baby causes different emotion ranging
The aim of this research is to measure proportion of
from happiness to fear and anxiety. Many mothers
postpartum depression in Saudi women. Also to
experience "baby blues" after child birth that
identify the social and psychological factors that
include mood swings and crying sensitivity that
related to postpartum depression.
resolve quickly without any interference. If they
last for long duration it becomes a form of
depression that is known as postpartum depression.
Study design: observational descriptive cross
Postpartum Depression (PPD) is defined
sectional-hospital based study
briefly as a "complication of birth where its reasons
Study area: Saudi Arabia, Riyadh, Central Region
are differing from a carrier mother to mother".
(King Abdullaziz Medical City, Alyamamah
Symptoms of PPD resemble those of any other
depression disorders but PPD is characterized by
Study population: study participants were
the time of occurrence and period than any other
postnatal females who delivered less than seven
depression. Symptoms of PPD may include loss of
days at hospitals' gynecology wards and postnatal
appetite, insomnia, intense irritability, anger,
females after eight weeks of delivery at hospitals'
fatigue, lack of joy in life, sever mood swings and
OBGYN clinics. Ages are between 18-45 years
the most worrisome symptom is hearing thoughts of
hurting self or baby. Untreated PPD may last for
Sample size & technique: The study included 150
months or longer (1). Factors leading to PPD are
postnatal females, selected randomly. Females of
many but what this paper is interested is discussing
medical disorders excluded.
the psychological and social factors.
Data needs and collection tool: the data collected
Some examples on psychological factors are:
through structured questionnaires, in addition to
having a history of abuse, having an existing mental
illness and not wanting to have the baby. On the
Questionnaire was in English first then translated to
other hand social causes may include; the existence
Arabic. First section included socio-demographic
of support groups that she attends their support
information, second section included questions to
scissions or not, social avoidance and if her
determine whether or not the female had
husband is standing beside her or not (2).
postpartum depression and the third and fourth
Received: 20/12/2017 DOI: 10.12816/0044755
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1801-1807
Satisfaction Level Among Nephrologists towards Chronic Kidney
Disease Patients Referred from Primary Health Care System
Abdulmalik A. Alkhodair*1; Saud N. Aleisa*1; Mushref A. Alghamdi1;
Abdulaziz A. Alodhayani2; Yasser A. Alghamdi3,Yasir I. Alsenaidi4
1Medical Intern, College of Medicine, Al-Imam Mohammed ibn Saud Islamic University,
Riyadh, Saudi Arabia;
2Assistant Professor of Family Medicine Department, King Saud University, Riyadh, Saudi Arabia
3Consultant Nephrologist, Prince Mohammed Bin Abdulaziz Hospital (PMAH), Riyadh, Saudi Arabia
4 Family Medicine Department, Al-Imam Mohammed ibn Saud Islamic University, Riyadh, Saudi Arabia
*Correspondence: Abdulmalik A. Alkhodair, E-mail: Abdulmalikak@hotmail.com and Saud N. Aleisa, E-mail:
Background: chronic kidney disease (CKD) risk factors have been increased in the Saudi
population. Therefore, primary health care physicians play a major role in controlling these risk factors, and
prevent further kidney damage. Sometimes, Nephrology consultation is needed to provide them with an
ideal medical care as soon as the diagnosis is made. Purpose: The aim of the study was to assess the level
of satisfaction among nephrologists towards primary health care referral system.
Methods: a cross-sectional study was carried out in Riyadh city, Saudi Arabia. Participants
were nephrologists who work in major hospitals. A designed questionnaire was used for data collection
consisted of demographic data of the participant, causes of referral, quality of referral forms, and patients'
care prior referral.
Results: a total of 89 nephrologists were recruited in the study, most of them were males and non-Saudi
physicians. Confirming the diagnosis and providing recommended treatment for the patients are the most
common causes for referral. Most of the participants were satisfied about quality of referral
and prior referral care. There was no difference in the satisfaction level among consultants compared to
specialists. Whereas, private sector nephrologists were more satisfied.
Conclusion: Governmental hospitals have to work harder to improve their health system, as they are the
main source for most of Saudi citizens' health problems. Providing a nephrologist with good referral letter,
and good communication between primary care physicians and other medical specialties provides a better
health care to the patients.
Keywords: End Stage Kidney Disease (ESKD), Kidney Failure, Referral Letter, Referral System, Primary
Health Care Center.
nephrologist consultations due to his complicated
Chronic kidney disease (CKD) is one of
disease or initiation of kidney dialysis. As a
the most common non-communicable diseases
result, each patient should get his optimal medical
affecting the globe (1). It is a progressive disease
care as soon as his/her diagnosis is made.
associated with considerable morbidity and
Recently, Saudi Center for Organ
mortality. However, early stages in CKD are
Transplantation (SCOT), has reported that more
usually silent and without obvious symptoms,
than 16 thousand patients are suffering from
patients may not be aware of their disease (2).
CKD in Saudi Arabia, of those, more than 15
Hence, primary health care physicians have an
thousand are on hemodialysis. Furthermore, there
important role in the identification and early
are around 198 nephrology consultants and 308
management of CKD patients. Additionally,
nephrology specialists in all hospitals sectors (4).
some patients need an early nephrologist
The purpose of this study is to assess the
evaluation to improve their quality of life and
level of satisfaction of nephrologists towards
prevent possible serious complications.
primary health care referral system, in terms of
Pre-ESRD nephrology care, which is
causes of referral, quality of referral forms, pre-
known as early referral of patients with CKD to
referral care, and timing of referral.
specialized renal services (3). Furthermore, each
CKD patient has his/her own medical condition
MATERIAL AND METHODS
which has a different management; some of those
Study design and setting
patients can be managed by primary care
This is a cross-sectional study. It was
physicians. On the other hand, some need
carried out in Riyadh city, Saudi Arabia. This
Received: 20/12/2017 DOI: 10.12816/0044756
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1808-1812
Melanoma Awareness and self-examination Practices in Saudi Arabia
Amir Khogeer, Azzam Khogeer, Ammar Alkhiary,Faisal Almaghyadi, Mahmoud Khan
King Abdulaziz University, Jeddah, Saudi Arabia
Background: Althoughmelanoma rationalizes less than 1% of cases with skin cancer, it accounts for the
greater number of skin cancer deaths.
Objectives: The objective of this study was to investigate the current knowledge and self-examination
practices in Saudi Arabia.
Subjects and methods: A cross-control study was conducted using an anonymous web-based survey. A
total of 203subjects from Saudi Arabia took part in this survey during the period from 11 December 2017 to
23 December 2017.Participants were asked to fill an anonymous survey about their demographic
characteristics, knowledge, attitudes, and practices regarding early detection of melanoma.
Results: The majority of the subjects were males (55%), university/post graduates (78%), single (83%) and
have no children (89%).Around 76% of our population was aware of melanoma, about 65% were aware of
its risk factor, and about 55% could identify its early symptoms. The greater number of subjects 196(96.6%)
reported that they did not conduct self-examination.
Conclusion: Despite the fact that the majority of our population was aware of melanoma, our study
suggests designing and implementing awareness campaigns and programs to highlight the importance of
early detection of melanoma and skin self-examination (SSE).
Keywords: Melanoma, Awareness, Self-examination, Skin, Survey.
demographics. The rest of the questions were to ask
Melanoma is defined as a form of cancer that begins
about the extent of the current knowledge and
in melanocytes 1. Despite the fact that it rationalizes
performing self-examination of melanoma.
less than 1% of cases with skin cancer, it accounts
for the greater number of skin cancer deaths2.
Data were statistically described in terms of
As reported by National Cancer Institute (NCI), in
frequencies (number of cases) and valid percentages
2014, an estimate of 1,169,351 patients were
for categorical variables. Mean, standard deviations,
suffering from skin melanoma in the United States.
minimum and maximum were used to describe
Skin melanoma represents 5.2% of all new cancer
numerical variable. All statistical calculations were
cases in the United States3.
done using computer program IBM SPSS (Statistical
Previous studies were conducted to investigate and
Package for the Social Science; IBM Corp, Armonk,
document the current knowledge and self-
NY, USA) release 21 for Microsoft Windows.
examination practices of melanoma4,5,6 but little is
known in the Saudi population.
The aim of this study was to investigate the current
Participants' characteristics (N=203):
knowledge and self-examination practices of
Collecting demographic data from subjects revealed
melanoma in Saudi Arabia.
that 111 (54.7%) were males while 92 (45.3%) were
females, with a mean age of 23.4 ±7.1 years.
MATERIALS AND METHODS
The majority of subjects 159(78.3%) were
Subjects: This cross-sectional study was conducted
university/post graduates, 39 (19.2%) received
using an anonymous web-based survey. A total of
secondary education, 4 (2.0%) received intermediate
203 subjects from Saudi Arabia took part in this
education while only one (0.5%) subject completed
survey. Participants were asked to fill an anonymous
survey about their demographic characteristics,
Regarding marital status, the majority of subjects
knowledge, attitudes, and practices regarding early
169(83.3%) were single, 32 (15.8%) were married
detection of melanoma. The survey was conducted
and only one (0.5%) subject was divorced and
during the period from 11 December 2017 to 23
another one (0.5%) was widowed.
December 2017. Institutional review board approval
Subjects were also asked about the number of
was obtained before conducting any study-related
children they have. The majority 180(88.7%)
procedures. The study was done after approval of
reported that they do not have children while only 23
ethical board of King Abdulaziz university.
(11.3%) reported that they at least have one
Data collected: The survey consisted of 13
child.Further details are provided in table (1).
questions. The first five questions were about
Received: 20/12/2017 DOI: 10.12816/0044757
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1813-1817
A Study of Tetany among The Saudi Population
Esraa Ahmed Alshareef 1 , Ziyad Zaid Alkathiri 2 , Reem Ibrahim Al Rashidy 3 , Alwaleed
Fayduallah M Al-Idriss 4 , Roaa Kamil Jumbi 5 , Fatimah Abdulkarim Al-Abdulkarim 6 ,
Althobite,Abdulaziz Saleh W 7 , Rahaf Essam Kutbi 8 , Nayef Muaazzi Saleh Alblowi 9 , Esraa
Jamel A Subahi 8 , Yousef E Yousef jan 10
1- National Guard Hospital , 2- Alfaisal University , 3- AlQassim university UCM,4- General physician
MCH mecca , 5- Clinical audit administration, directorate of health affairs in Jeddah , 6- General
physician , King Fahad Hospital in Hofuf , 7- Tianjin Medical University , 8- Ibn Sina college , 9- King
Salman Armed Forces Hospital - North Western Region , 10- PHC - makkah
Aim of the work: studies mentioning etiological distribution of tetany are rare and responsiveness
concerning it is poor among physicians so, we tried to describe different causes of tetany beyond the
decrease in total serum calcium level. Methods: patients with overt or latent tetany were assessed
clinically and from laboratory investigations. Initial examinations completed were serum calcium,
potassium and arterial blood gas analysis. Both ionized and total calcium were evaluated and corrected
according to serum albumin level. Depending on initial reports, additional tests were completed for
example, alkaline phosphatase, serum phosphate, parathyroid hormone and magnesium levels; and urine
potassium, calcium and chloride levels. Results: Gitelman's syndrome (GS), Bartter's syndrome (BS),
recurrent vomiting, anxiety hyperventilation, vitamin D3 deficiency (VDD), idiopathic
hypoparathyroidism (IHP), postoperative hypoparathyroidism (PHP), acute pancreatitis, tumor lysis
syndrome (TLS) and hypomagnesemia were the different causes of tetany identified. Out of 106 patients,
total serum calcium was normal in 82 patients with metabolic or respiratory alkalosis (GS, BS, recurrent
vomiting, and anxiety hyperventilation). Total calcium was low only in 24 patients (in VDD, IHP, PHP,
acute pancreatitis, TLS and hypomagnesemia). Ionized calcium was low in all patients. GS was the most
common (38%). Recurrent vomiting (19%), anxiety hyperventilation (13%), and VDD (11%) were also
common. PHP was less common (4%); acute pancreatitis, TLS, hypomagnesemia and IHP were
uncommon. Conclusion: tetany has diverse etiologies. Both metabolic and respiratory alkalosis caused a
decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than
decreased total calcium should be kept in mind for early etiological diagnosis of tetany.
Keywords: hyperventilation, hypocalcemia, Gitelman's syndrome, vitamin D3 deficiency, vomiting.
literature. We conducted this study to identify
Tetany is categorized by variable combinations
the relative frequencies of different causes of
of features comprising cramps, muscle twitching,
tetany and to make the primary care physicians
circumoral numbness, paresthesias of hands and
aware about the different causes of tetany
feet, laryngeal stridor, carpopedal spasm, and
beyond the decrease in total serum calcium level.
convulsions (due to cerebral vasoconstriction).
Trousseau sign (carpopedal spasm observed
following application of inflated blood pressure
Both female and male patients admitted as
cuff over brachial artery 20 mmHg above
inpatients in general medical ward in King
systolic blood pressure for 3 min) and Chvostek
Abdulaziz hospital over 2 years period with
sign (twitching of circumoral muscles with
symptoms or signs of overt or latent tetany were
tapping on facial nerve below zygomatic
comprised in this study. Patients with movement
process 2 cm anterior to earlobe) unmask latent
disorders or epilepsy were excluded from the
tetany in patients with numbness, tingling and
study to avoid confusion.
cramps in extremities. The reduction in serum
Basic demographic data of the patients were
calcium causing tetany is well known .
gathered. For creating the etiology of tetany,
Nonetheless, decrease in ionized calcium is
detailed history of patients was taken containing
more significant than total calcium level, as it is
current and past h/o recurrent vomiting,
the biologically active component. In different
weakness of limbs, anxiety disorder, abdominal
causes of tetany, total serum calcium can be
pain, thyroid and neck surgeries, presence of
normal when ionized calcium was low .
polyuria and polydipsia, h/o drug intake,
Awareness regarding the etiological spectrum of
chemotherapy for malignant disorders, and
tetany is very poor amid physicians. Studies on
family h/o similar disorders. The detailed
the etiological distribution of tetany are rare in
clinical examination was completed to discover
Received: 20/12/2017 DOI: 10.12816/0044758
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1818-1822
Causes and Management of Ovarian Cysts
Zina Abdulkareem Al Zahidy
Ibn Sina National College
An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. While the discovery
of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of
these lesions are benign. Most patients with ovarian cysts are asymptomatic, with the cysts being discovered
incidentally during ultrasonography or routine pelvic examination. Some cysts, however, may be associated
with a range of symptoms, sometimes severe. Many patients with simple ovarian cysts found through
ultrasonographic examination do not necessitate treatment. In a postmenopausal patient, a persistent simple
cyst smaller than 10 cm in dimension in the presence of a normal CA125 value may be monitored with serial
ultrasonographic examinations. When ovarian cysts are large, persistent, painful or have concerning
radiographic or exam findings, surgery may be required, sometimes resulting in removal of the ovary. We
conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane database
of systematic reviews and Cochrane central register of controlled trials from January 1, 1995, through
January 1, 2017.
Keywords: ovarian cysts, fetal and neonatal cysts, laparotomy and laparoscopy.
An ovarian cyst is a sac filled with liquid or
appendicitis, or ectopic pregnancy, to evaluate for
semiliquid material that arises in an ovary. The
the likelihood of neoplasm or malignancy and
number of diagnoses of ovarian cysts has improved
either to refer the patient to the suitable consultant
with the widespread carrying out of regular
or to discharge them with a clear plan for follow-up
physical examinations and ultrasonographic
with an obstetrician/gynecologist.
technology. The detection of an ovarian cyst causes
substantial anxiety in women owing to fears of
MATERIALS AND METHODS
malignancy, but the vast majority of ovarian cysts
· Data Sources and Search terms
are benign. These cysts can progress in females at
We conducted this review using a comprehensive
any stage of life, from the neonatal period to post
search of MEDLINE, PubMed, EMBASE,
menopause. Most ovarian cysts, nonetheless, arise
Cochrane Database of Systematic Reviews and
during infancy and adolescence, which are
Cochrane Central Register of Controlled Trials
hormonally active periods of development. Most
from January 1, 1995, through January 1, 2017.
are functional in nature and resolve without
· Data Extraction
treatment. However, ovarian cysts can herald an
Two reviewers independently reviewed studies,
underlying malignant process or, probably, distract
abstracted data and resolved disagreements by
the clinician from a more unsafe condition, for
consensus. Studies were evaluated for quality. A
example, appendicitis, ovarian torsion, or ectopic
review protocol was followed throughout.
pregnancy. (Conversely, there could be an inverse
association between breast cancer and ovarian
Signs and symptoms
cysts). Once ovarian cysts are large, painful,
Most patients with ovarian cysts are
persistent or have concerning radiographic or exam
asymptomatic, with the cysts being discovered
findings, surgery may be required, from time to
incidentally during ultrasonography or routine
time resulting in removal of the ovary [1, 2].
pelvic examination. Some cysts, however, may be
Abdominal pain in the female can be one of the
associated with a range of symptoms, sometimes
most difficult cases to diagnose correctly in the
severe  , while malignant ovarian cysts frequently
emergency department (ED). The spectrum of
do not cause symptoms until they reach an
gynecologic disease is broad, spanning all age
ranges and representing numerous degrees of
Pain or anxiety may arise in the lower abdomen.
severity, from benign cysts that eventually resolve
Torsion (twisting) or rupture may lead to more
on their own to ruptured ectopic pregnancy that
severe pain. Cyst rupture is characterized by
sudden, unilateral, sharp pelvic pain. This can be
obtainable with this scenario, the goal of the
allied with trauma, exercise, or coitus. Furthermore,
emergency physician is to rule out acute causes of
cyst rupture can lead to peritoneal signs, abdominal
abdominal pain related with high morbidity and
distention and bleeding that is commonly self-
limited [3, 4] .
Received: 20/12/2017 DOI: 10.12816/0044759
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1823-1825
Knowledge about Cervical Cancer among Women in Saudi Arabia
Samaher Sahal Malibari
College of Medicine, Umm Al-Qura University
Aim of the work: cervical cancer is considered as a major wellbeing danger towards women. Many studies
have shown that even with the high prevalence of cervical cancer the awareness of cervical cancer, cervical
screening and human papilloma virus (HPV) is very low. This study aimed to evaluate the level of
awareness of cervical cancer, Pap smear test and HPV among women in Saudi Arabia. Methodology: this
descriptive cross-sectional study was conducted among women in Saudi Arabia during the period from
October 2017 to January 2018. A total of 412 participants were included in this study. Data were collected
by using pre coded structured questionnaire. The data were analyzed by using the SPSS. P value less than
0.05 was considered significant. Results: the overall knowledge level of cervical cancer was good (78.6%),
but it was low regarding the HPV (16.4%) and Pap smear screening test (35.9%). Conclusion: this study
concluded that the level of knowledge about cervical cancer was generally good among women in Saudi
Arabia, but there was low knowledge regarding Pap smear test and HPV as a main cause of cervical cancer
and as sexual transmitted disease. There was a need for health education to increase the awareness of
cervical cancer among women in Saudi Arabia.
Keywords: cervical cancer, knowledge, Pap smear, human papilloma virus (HPV).
treatment of the discovered patient before
Cervical cancer remains to be a major
development if the disease (13, 14).
wellbeing danger towards women. In 2010
Human papilloma virus (HPV) is a sexually
cervical cancer was the fifth most fatal cancer in
transmitted infection that considered the most
women (1). It was documented worldwide as the
important cause of cervical cancer (15).
fourth most common cancer in women by the year
Worldwide, it has been estimated that 75% of
2012, with about 528,000 new cases and 266,000
sexually active adults during their life had HPV
died of cervical cancer (2). It considered one of the
infection (16). Many sexual partners, sexually
important causes of gynecological cancer
transmitted infections (STIs), early sexual activity
associated mortality and morbidity in the
and smoking is considered risk factors for
developing countries (3,4). Fortunately, cervical
cervical cancer. To reduce the risk of cervical
cancer is considered as one of the rare preventable
cancer, women must do routine Pap tests, being
malignant tumors. The prevention of the cervical
vaccinated against HPV, stop smoking and
cancer is done by screening tests and early
practice safe sex (15,17).
detection of precancerous lesions (5,6). The
The USPSTF (U.S preventive services task
incidence of cervical cancer declined in the
force) recommends screening for cervical cancer
developed countries because the awareness of the
in women from age 21 years up to 65 years with
cervical cancer and the screening tests (7, 8).
cytology (Papanicolaou smear) every 3 years or,
Many studies have shown that even with
for women aged 30 years to 65 years screening
the high prevalence of cervical cancer the
with a combination of cytology and HPV testing
awareness of cervical cancer, cervical screening
every 5 years (18). This study aimed to evaluate the
and human papillomavirus (HPV) is very low (9,
level of awareness of cervical cancer, Pap smear
10). This highlights the need of increased
test and HPV among women in Saudi Arabia.
awareness of the cervical cancer among women
The cervical cancer screening test is called
This descriptive cross-sectional study was
Papanicolaou (Pap) smear. The Pap smear test is
conducted among women in Saudi Arabia during
considered proficient, inexpensive and an
the period from October 2017 to January 2018. A
effective technique in discovering cytological
total of 412 participants were included in this
changes in the cervix. The Pap smear shows an
study. Data were collected by using pre coded
important role in screening programs and has an
structured questionnaire, to collect required data
obvious role in reducing both the incidence and
about socio demographic characteristics of the
mortality of cervical cancers (12). The aim of
respondents, their knowledge about cervical
routine screening is to discover early cytological
cancer screening tests and their predisposing risk
abnormalities for example dysplasia and early
factors. The data were analyzed by using the
SPSS (Statistical Package for the Social Sciences)
Received: 20/12/2017 DOI
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1826-1833
The Prevalence of Acute Myocardial Infarction (AMI) in Taif City
Province and its Participating Factors
Nouf Jafar ALzahrani1,Nawal Swailem ALotaibi1 , Nesriene M. El Margoushy1,
Mohammed M. Mougrabi2
College of medicine, Taif University, 2. Cardiology Department, King Faisal Hospital, Taif, Saudi Arabia
Background: Myocardial infarction (MI) is a fatal disease caused by block in the oxygen supply of blood
vessels of the heart muscles, leading to permanent heart muscle damage and death of its cells. Aim of work:
to assess the relationship between incidence of acute myocardial infarction and its participating factors.
Patients and methods: observational, descriptive correlation questionnaire based study on 50 Saudi and non
Saudi patients with acute myocardial infarction who were admitted in cardiac intensive care unit (CICU),
medical ward and followed in out-patient department (OPD). They were chosen from King Faisal Medical
Center, cardiology department, Taif, Saudi Arabia from the first of March 2016 to the end of April 2016 (2
months duration). Results: Prevalence of MI patients in the 2 months of research was 1.4%. MI was
precipitated by a number of factors in Saudi Arabia as old age, increased body mass index, stress, obesity and
consumption of high caloric rich diet. Conclusion: The main risk factors of ACS in our patients were
hypertension, Stress, obesity; high cholesterol diet and positive family history of cholesterol in addition to old
age and smoking.
Recommendations: Combating precipitating factors of MI in Saudi Arabia can decrease the prevalence of
Keywords: Myocardial Infarction,Taif City, Participating Factors.
is physical factors as high blood pressure, increased
Myocardial infarction (MI), is a subset of acute
waist circumference and improper body mass
coronary syndrome, in which there is damage to the
index; fluctuation in body weight is associated with
cardiac muscle as demonstrated by increased
high mortality and high rate of cardiovascular
cardiac Troponin levels in the setting of acute
events independent of other cardiovascular risk
ischemia (1). Myocardial infarction (MI) is a fatal
factors (4). The third category is biochemical factors
disease caused by block in the oxygen supply of
as high blood pressure and lipids. First degree
blood vessels of the heart muscles, leading to
relatives of coronary artery disease patients have a
permanent heart muscle damage and death of its
high risk of getting cardiovascular diseases due to
cells. This block is due to atherosclerosis in which
genetic factor in addition to environmental factors
plaque of fatty patches is precipitated on the inner
as life style, eating habits like dyslipidemia and
wall of the coronary artery or one of its smaller
glucose metabolism abnormalities, exercise and
branches. When the plaque is ruptured, the blood
socio-economic status which make members of the
clot is formed inside the artery blocking the blood
same family more prone to non- communicable
flow (2). According to world health organization
diseases (5). While the classic symptoms of a heart
(WHO) report published in 2014, 68% of global
attack are chest pain and shortness of breath, the
deaths annually related to non communicable
symptoms can be quite varied. The most common
diseases such as cardiovascular diseases (CVD),
symptoms of a heart attack include: pressure or
respiratory diseases, diabetes mellitus and cancer,
tightness in the chest, pain in the chest, back, jaw,
with peak incidence of 40% in the age group from
and other areas of the upper body that lasts more
30 - 70 years. Cardiovascular diseases constitute
than a few minutes or that goes away and comes
31% of these deaths denoting that they are the
back, shortness of breath, sweating, nausea,
leading cause of death (3). Risk factors of
vomiting, anxiety, cough, dizziness and palpitation.
cardiovascular diseases can be classified into three
30% of population present with atypical symptoms,
categories the first one is behavioral factors as
this is more predominant in women. So women
eating un healthy food, smoking, alcohol intake,
above 75 years old have had an MI with little or no
and lack of physical exercise, the second category
history of MI symptoms. Most myocardial
Received: 20/12/2017 DOI: 10.12816/0044761
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1834-1841
Pattern of Thyroid Diseases in Arar City, Northern Saudi Arabia
Shahad Lafi Alanazi1, Nagah Mohamed Abo El-Fetoh2, Hadil Mohammed Alenezi1,
Wasan Lafi Alanazi1, Khulud Falah Alanazi1, Adhwaa Saud Alruwaili1, Ohud Falah Alanazi1,
Alaa Jameel Ahmed1, Nawal Ahmed Alshammari1, Maha Mukhlef Alanazi1,
Aeshah Raja Alanazi1, Mashael Jaza Alshammari1
1Medical Student, Faculty of Medicine, Northern Border University, 2Associate Professor of Community
Medicine, Community Medicine Department, Faculty of Medicine, Northern Border University, KSA.
Background: Thyroid hormone acts as a vital factor of development and growth, and in adults plays a
critical part in the regulation of the function and metabolism of virtually every organ system.
Study objective: The objective of this study was to identify the pattern of hypothyroidism and
hyperthyroidism in Arar, Northern Saudi Arabia and some related socio-demographic determinants.
Methodology: A cross-sectional study was conducted in Arar, Northern Saudi Arabia. A multistage
stratified random sampling technique was used. A pre-designed online questionnaire was distributed among
the targeted population and filled by participants after a brief introduction or explanation of the idea of the
research to the public. Sampled participants filled out the self-reported predesigned questionnaire to collect
socioeconomic and thyroid diseases related data.
Results: The study included 160 participants. The total prevalence of thyroid diseases was 36(22.5%). Of
the 36 reported cases of thyroid diseases, 11(30.5%) were reported as having hyperthyroidism and
25(69.5%) were having hypothyroidism. Of the 11 patients with hyperthyroidism9 (81.8%) were males and
2(18.2%) were females. Of the 25 patients with hypothyroidism, 4(16.0%) were males and 21(84.0%) were
Conclusion: Hypothyroidism is the prevalent form of thyroid diseases in Arar, Northern Saudi Arabia,
females: male ratio was about 1:5. Knowledge of various factors influencing thyroid dysfunction can help
the public to guard against these prevalent diseases. More studies should be carried out in Arar city to stress
on the individual thyroid disorder. The studies should be community based with clinical and laboratory
diagnosis of cases.
Keywords: Hypothyroidism; Thyroid diseases; Hyperthyroidism; Arar, Northern Saudi Arabia.
Thyroid diseases are, arguably, among the
increasing goiter size. Although thyroid nodules are
commonest endocrine disorders worldwide. There
common, thyroid cancers are rare .
are four general types of thyroid diseases
Thyroid diseases are frequently misunderstood
and are too often overlooked and misdiagnosed.
abnormalities and tumors). The symptoms of
Morbidity associated with thyroid diseases is well
thyroid disease vary depending on the type .
known with deleterious consequences in terms of
Hypothyroidism results from reduced effects of
both elevated serum cholesterol levels and
thyroid hormone on tissues. Hypothyroidism is
increased risk of coronary artery disease and
more common in women and has a total prevalence
cardiovascular mortality .
of 1% to 2% increasing with age .
A study conducted in Hail region in KSA
Hyperthyroidism is the condition that occurs due
reported that; 175 patients complaining of different
to excessive production of thyroid hormone by the
thyroid disorders, (56%) of them were found to
thyroid gland. The main hyperthyroid conditions
are ( Graves' disease, Toxic thyroid nodule, Thyroid
hyperthyroidism. Iodine deficiency was associated
storm, toxic nodular struma and Hashitoxicosis). In
with hypothyroidism in females but it was common
the United States hyperthyroidism affects about
in males with hyperthyroidism. Total cases with
1.2% of the population .
goiter were 89 most of them were males (60.7%)
palpable goiter was more common (75.5%) than
enlargement of the thyroid gland (Goiter, Lingual
visible type. Malignant thyroid was found mainly in
thyroid and Thyroglossal duct cyst). Regarding
males (75%) with papillary type of cancer (64.3%)
thyroid tumors, the clinical presentation of thyroid
and the common presenting manifestation was
cancer is usually as a solitary thyroid nodule or
hyperthyroidism (53.6%) .
Received: 20/12/2017 DOI: 10.12816/0044762
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1842-1846
Bacteria Patterns in Infected Diabetic Foot: Is There a Surgical Implication?
Yazeed Aldhfyan, Anthony Morgan, Munahi Alsubaie, Abdulrahman Alzahrani
Department of General Surgery, Prince Sattam bin Abdulaziz University,
Corresponding author: Yazeed Aldhfyan,E-mail: Ydhfyan@gmail.com
Background: The number of patients suffering from diabetes and its complications in the world is doubling every
10-15 years. Apart from development of retinopathy, nephropathy, and diabetic-induced atherosclerotic changes in
high caliber arteries. Critical ischemia with gangrenous changes of the lower limb has occurred quite often as a
result of micro-angiopathy.
Objective: This study aimed to investigate the bacterial spreading and related outcomes of treatment in 81 patients
with diabetic foot complicated by infection.
Materials and methods: A retrospective study based on the analysis of the patients medical records from the
hospital database. The bacteriological analysis of the tissues from infected wounds, obtained during surgical
debridement or amputation, were conducted in all patients. Microbiological investigations of the the contents of an
aerobic and anaerobic bacterial flora in the wounds were compared and analyzed in all cases considered suitable
for this study.
Results: Analysis of microbial spreading revealed growth of bacteria in all diabetic foot wounds. Associations of
aerobes with anaerobes were found in 89.9 % of the cases. Escherichia coli was the dominating agent among
anaerobes (22%), leading to development of infectious process and distributed in a proximal direction along
synovial-tendon sheets of the foot.
Conclusion: Aggressive debridement of necrotized tissues, including proximal and distal parts of tendons up to 5
cm within the limits of healthy looking tissues may disrupt further spreading of purulent infection and lead to
Keywords: diabetic foot, diabetic infection, diabetic complications, bacterial spreading.
traumatic amputations of the lower extremity are
Currently diabetes mellitus is one of the major
made for patients with diabetes mellitus. 7
problems of modern endocrinology. The number of
A leading role in the development of a necrotic
patients suffering from this condition and its
process in diabetic foot has fast spreading of
complications in the world is doubling every 10-15
infection in a proximal direction in conditions of
years1,2. Apart from development of retinopathy,
angiopathy and neuropathy. However, mechanisms
nephropathy, and diabetic-induced atherosclerotic
and pathways of distribution of infection in foot and
changes in high caliber arteries. Critical ischemia
shin are not clear and poorly understood.9,10 The
with gangrenous changes of the lower limb has
aims of this study were to analyze the diabetes
occurred quite often as a result of micro-angiopathy3,
related infections and investigation of possible
4. The attention of the surgeons first of all is
correlations with the rate and level of amputations.
attracted by the fast development of necrotizing
We believe that a better understanding of the
processes in distal foot associated with a virulent
problem could increase the effectiveness of surgical
infection which leads to high morbidity and
treatment of diabetic foot.
mortality. Among some major reasons in
Also, the identification of bacterial patterns in
development of this complication are late detection
complicated infected diabetic foot and their possible
of diabetes, the aggressiveness of the disease, lack of
dynamic self-assessment, and poorly controlled
hyperglycemia.5, 6 As a result of critical ischemia
MATERIALS AND METHODS
concerning gangrene of the lower extremity, more
This retrospective study was based on the data
than 200.000 high amputations performed annually
obtained from the Department of Surgery at King
in the world. According to the World Health
Khaled Hospital in Al Kharj city with population in
Organization data, from 45 up to 70% of non-
the region over 650,000 people. Medical records of
81 patients admitted from 2010 to 2015 with
Received: 20/12/2017 DOI
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1847-1850
Prematurity as an Obstetric Complication and its awareness in Saudi Population
Nuha Hazem Bukhari1, Majed Abdulkarim Alaama1, Bayan Mohammed Alkhalili1,
Elaf Fawaz Alharbi1, Sara Ali Beshlawi1, Alanoud Ali Alhamed1, Bayan Ali Alqarni1,
Zahra'a Abdullah Ebrahim Assmary2.
1 Ibn Sina National College, 2 Umm Alqura University
Corresponding Author: Nuha Hazem Bukhari - Noha.Bukhari1414@gmail.Com
Background: Prematurity is a major obstetric complication that affects infants' growth and development, and is
also a big cause of infant mortality across the world. Prematurity is associated with certain risk factors, such as
age extremes, mother's diet and health, multiple pregnancies, maternal infections, maternal smoking, inadequate
follow-up, and insufficient management of maternal chronic diseases.
Aim: In this study we aim to study knowledge and attitude of pregnant women toward the prematurity causes and
Methodology: We conducted a cross-sectional study, of 2470 women who presented in king Abdulaziz
University, Jeddah, Saudi Arabia from April 2017 to December
Conclusion: We noted that although most mothers were aware of the positive impact on their health by regular
follow-up visits to physician, many of them were not largely informed of the common associated risk factors.
Better prenatal counselling can help create better awareness.
Keywords: Prematurity, Obstetric Complication.
Premature birth is defined as any birth before 37
Prematurity disturbs a wide range of organ
weeks of gestation. Every year, 15 million babies are
systems. Some of the complications throw lifelong
born prematurely . Many of these babies are able to
consequences for the growth, development, and
survive normally, but a big number of them may die
health of infants born prematurely. The multifaceted
or live a life with chronic morbidity. Across the
interplay of the mechanisms that take part in preterm
globe, the rate of premature birth averages 11% but
delivery includes inflammation and cytokine injury.
this number changes with race and geography, with a
These mechanisms are believed to be the factors
range of higher than 15% in some areas of Africa to
behind the pathogenesis of respiratory distress
56% in most European nations and lower in parts of
syndrome, development of chronic lung disease,
East Asian countries .
apnea, necrotizing enterocolitis, retinopathy of
In most parts of the world, the rate of premature
prematurity, sepsis, and brain white matter injury in
birth has increased in recent years and is now the
the infant [4-7].
leading cause of neonatal death across the world and
Causes behind premature birth are complex and
the second major cause of death among children up to
the exact pathophysiology that triggers preterm birth
5years of age. Determining how to lessen the rate of
is mostly unknown, nevertheless, contributing
this major pregnancy complication needs to be the
maternal, fetal and placental influencing causes have
highest priority in present-day health care. For infants
been identified. The most common ones comprise of
who do survive despite prematurity, there exists a
antepartum hemorrhage or placental abruption;
high risk for chronic non-communicable diseases and
certain mechanical factors including uterine over-
lasting cognitive disorders.
distention and cervical incompetence; changes in
Preterm birth has been linked with raised plasma
hormones; as well as, bacterial infection and
insulin levels, greater risk for cardiovascular diseases
subsequent inflammation [8; 9]. Infants born with
in adulthood, and abnormal growth patterns. The
multiple pregnancies are at higher risk to be born
frequency of prematurity and subsequent risk of death
prematurely because of spontaneous labor or due to
due to prematurity-related conditions is hence an
premature rupture of membranes, or because of other
indicator of access of women in a given country to
conditions such as fetal disorders and pre-eclampsia
have safe and effective, medical care prenatal and
postnatal, along with an indicator of the inclusive
health of their society .
Received: 20/12/2017 DOI: 10.12816/0044764
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1851-1857
Factors Hindering the Healthy Subjects from Attempting Their
First Blood Donation-A Cross-Sectional Study among The Citizens of
Jeddah City, Saudi Arabia
Leena Alsaiari*, Mohammad Qari, Nouf Al-Dawsari, Amir Khogeer, Danah Omran,
Weaam Waggas, Randa Sultan, Amani Al Mojeb
Faculty of Medicine, Medical College, King Abdulaziz University, Jeddah-21441, Kingdom of Saudi
Arabia. P O Box: 80215
*Correspondence address: Leena Abdul-Aziz Alsaiari, Telephone: +966555899581,
Email Address: firstname.lastname@example.org; email@example.com
Background and Aims: Blood donation (BD) is described as altruistic behavior and one of the life-saving
practices. The deficit of blood supply from BD has become a global concern. Knowledge, attitude, practice,
and motivation play a key role in BD. This study is aimed to determine the factors that hinder the healthy
individuals who have not donated blood yet from BD, by exploring the demographic and other variables
among the citizens of Jeddah city, Kingdom of Saudi Arabia (KSA).
Methods: A cross-sectional descriptive study was carried out at Faculty of Medicine, King Abdul-Aziz
University (KAU), Jeddah, KSA, between June 01, 2016 to June 30, 2016. The study included 327
participants who were selected by convenient random sampling in the Jeddah City. The data was collected
by using the online distribution of the previously validated questionnaire.
Results: Half of the participants (51.1%) have good knowledge about BD. More than two-thirds of
participants showed a positive attitude towards BD. Majority of participants (87.7%) claimed that they will
donate blood if the recipient is a friend or relative. The most chosen reasons for not donating blood among
participants were BD did not cross their minds (23.9%), no time for BD (17.1%) and fear of needles
(13.8%). Mobile blood campaign (84.4%) and one day off (83.2%) were important motivating factors for
most of the participants. Almost half of the participants (52.29%) mentioned that BD should be non-
remunerable, 26.61% agreed that remuneration is a motive and 21.10% believe that any form of gift is
acceptable as a motivating factor for BD. Conclusion: Although most of the participants have good
knowledge and positive attitude towards BD, still numerous potential and eligible donors evade BD. More
awareness and motivational programmes are required to bring more individuals to the pool of regular donors.
Keywords: Attitude, blood donation, knowledge, motivation, practice, Saudi Arabia.
Generally, blood donors are categorized into
Blood donation (BD) is an imperative element
three categories: voluntary, family replacement or
of health care . It is a process of collection of
involuntary and paid donors. Voluntary donors are
blood, plasma or other blood components from a
those who donate blood of their own will without
donor and then transfusing it into recipient's body
. Blood transfusion has an essential role in the
Replacement donors are also unrewarded and they
management of various medical conditions such as
donate blood when their family member or friend
bleeding disorders, different surgical and medical
requires the blood transfusion while the last
procedures, trauma resulting from accidents, and
category is paid donors, who are remunerated in the
variety of acute and chronic hematological
form of cash or in kind which could be considered a
treatments like cancer therapy [1, 3]. World Health
substitute for money . Among the three types of
Organisation (WHO) Global Database on Blood
blood donors, voluntary unrewarded donors are
Safety (GDBS) reports that from 176 countries
considered as an appropriate and safe source of
nearly 112 million blood donors are donating blood
blood donation with respect to the possible disease
annually. Although blood transfusion improves
transmission through blood transfusion [6, 7]. These
health and sustains lives, still an abundant number
donors give blood for altruistic considerations and
of patients requiring transfusion have delayed
as an act of generosity to the society. There has
access to safe blood. To meet the increasing global
been a higher incidence of transfusion-transmitted
demands of blood transfusion, there is a dire need
infections among paid donors than non-
for health care services to consider the crucial rule
remunerated volunteer group .
of blood donation carefully . Therefore, the
Pertaining to the selection of the blood
deficit of blood supply from BD has become a
donors, Council of Europe and WHO has
worldwide concern .
recommended that blood and other components of
Received: 20/12/2017 DOI: 10.12816/0044765
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1858-1861
Awareness of Mothers about the Usage of Antibiotics and
the Risk of Preterm Baby
Majed Abdulkarim Alaama1, Nuha Hazem Bukhari1, Asalah Fahad Atyah Hamad1,
Rawan Mohamed Alatassi2, Hassna Hussein Alharthi3, Deem Hatim Al-Fandi4,
Aliyah Mowaffag Alanazi4, Duaa Saeed Alsaqer4
1 Ibn Sina National College, 2 Alfaisal University, 3 Taif University, 4 Almaarefa College
Corresponding Author: Majed Abdulkarim Alaama email: Dr.Majedalaama@ Gmail.Com
Background: Pregnant women are exposed to a wide range of medications, including antibiotics. Although
antibiotics are many times absolutely important to prevent and treat infections as well as prevent premature labor,
their overuse poses a threat to the growing fetus as well as the mother. The ill-effects of antibiotic over-use and
having them without prescription can cause developmental abnormalities in the fetus, known as teratogenicity.
They could also cause maternal allergic reactions, as well as long term effects on the child's immunity and
growth in future.
Aim: In this study we aim to study the knowledge and attitude of pregnant women toward usage of antibiotics
and risk of preterm baby.
Methodology: We conducted a cross-sectional study, of 2470 women who presented in king Abdulaziz
University, Jeddah, Saudi Arabia from April 2017 to December.
Conclusion: We noted that most mothers were aware of that they must not take antibiotics without prescription
while pregnant, especially for ailments such as common cold and abdominal pain. However, the pharmacists
must be regulated for unnecessary over-dispatching of antibiotics, especially without confirming the pregnancy
status of the costumers.
Keywords: Mothers, Antibiotics, Preterm Baby.
On the contrary, a big amount of data shows
A big number of women during their pregnancy
that antibiotic use is not exempt from serious
are exposed to some type of medication. Drugs that
adverse effects. Antibiotics are associated with
are prescribed during pregnancy can induce a
teratogenic effect on the developing fetuses. The
gastrointestinal troubles, and death . Additionally,
most frequently prescribed types of medication
development of multi-resistant bacteria a major
during pregnancy and lactation are antibiotics .
challenge associated with antibiotic overuse [6; 7].
Recent estimates show that more than 40% of
Antibiotic are inappropriately overused to treat
pregnant women receive some type of antibiotic
urinary, genital, respiratory, ear, nose and throat has
immediately before delivery, mostly for preventing
increased. The widespread consumption of
neonatal Group B Streptococcus (GBS) sepsis or as
antibiotics is related to maternal anaphylaxis at a rate
a cesarean prophylaxis [2-4].
of 2.7 cases per 100,000 deliveries . Maternal
In addition, antibiotic indications during
anaphylaxis has a distressing effect on fetal
pregnancy are also prescribed for screening and
oxygenation due to maternal hypotension which
managing asymptomatic bacteriuria and bacterial
compensates the fetus for decreased blood flow
vaginosis. Unfortunately, on many occasions,
putting the fetus at risk of hypoxic-ischemic
antibiotics are overused to treat respiratory and
encephalopathy as well as permanent central nervous
genital infections resulting in the big majority of
system damage [9; 10].
fetuses being exposed to antibiotics in utero.
Aside from anaphylaxis, it is proposed that
Antibiotics are very helpful in overcoming the
exposure to antibiotics through fetal and neonatal
preterm labor episode associated with infectious
life can lead to development of allergic diseases due
cause, and thus prolong pregnancy. A continuing
to their likely long-term effect on gut microbiota of
inflammatory environment due to infection could
both the fetus and the mother, as well as maternal
have led to premature contractions as well as fetal
vaginal microbiota. Antibiotic use might interrupt
brain injury and thereby resulting in cerebral palsy
and interfere with the early gut colonization of the
infant with microbiota . As a result of this delay
Received: 20/12/2017 DOI: 10.12816/0044766
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1862-1866
Prevalence of Metabolic Syndrome among Patients with Hypothyroidism
Shahad AbuAlhamael, Ammar Balkheyour, Omar Ashour, Shima Aziz, Hassan Alsini, Omar Alghamdi
King Abdulaziz University Hospital, Jeddah, Saudi Arabia
*Corresponding author: Shahad AbuAlhamael, Tell: +966503690185, Email: firstname.lastname@example.org
Background: hypothyroidism is of concern in our society; it has an effect on metabolic parameters.
Objective: this study aimed to predict the prevalence of metabolic syndrome (MetS) among patients with
hypothyroidism in Jeddah, Saudi Arabia and to determine the effect of treating hypothyroidism on MetS.
Methods: we conducted this cross-sectional study, in which MetS was defined by presence of at least three of the
five AHA/NHLBI criteria. We included patients with hypothyroidism that were managed in an outpatient
department or admitted in King Abdulaziz University Hospital from 1 March to 30 April 2016. We measured lipid
parameters, blood pressure (BP), waist circumference (WC) and serum fasting blood glucose (FBG).
Results: in total 57 patients were included in our study, of which 47 (82%) were females. the majority of patients
were greater than 50 years of age (n=35, 60%). We found that 36.8% of patients uncontrolled for hypothyroidism
had high levels of TSH (serum level of TSH >5 mlu/L) , while 64.9% of patients who were controlled for
hypothyroidism had normal levels of TSH (serum level of TSH 0.5 - 5 mlu/L). Overall, 71.9% (n=41) of
hypothyroidism patients had MetS. However, we found that 51.8% (n=21) uncontrolled hypothyroidism patients
suffered from MetS and 48.2% (n= 20) patients controlled for hypothyroidism suffered from MetS. However,
70.68 %, 31.03%, 34.48%, 79.31% and 70.6% of participants had abnormal waist circumference (WC),
hypertriglyceridemia, abnormal high-density lipoprotein (HDL), hypertension and elevated serum levels of fasting
blood sugar, respectively
Conclusion: hypothyroidism plays an important role in MetS. Future advanced studies including larger numbers of
patients are needed to test the effect of treating hypothyroidism on MetS. Routine screening for cardiovascular risk
factors in patients with hypothyroidism may unmask MetS.
Keywords: hypothyroidism, metabolic syndrome, euthyroid, medicine.
Abbreviations: WC: waist circumference, TG:
However, overt hypothyroidism is a condition
triglyceride, BP: blood pressure, HDL: high-density
characterized by high thyroid stimulating hormone
lipoprotein, FBS: fasting blood sugar, AHA:
(TSH) and low serum free thyroxine (FT4), and is
American heart Association, NHLBI: National Heart
closely related to dyslipidemic conditions and
Lung and Blood Institute.
coronary artery disease . Overt hypothyroidism is
reported as a recognized risk factor of atherosclerotic
cardiovascular disease, hyperlipidemia, low-grade
Hypothyroidism is a syndrome resulting from
inflammation and hypercoagulability, which in turn,
thyroid hormone deficiency, or in rare cases,
affect the cardiovascular system both directly by
inefficacy. It is a common endocrinological problem
altering cardiac function through changes in myocyte
particularly affecting women and the elderly . The
specific gene expression and indirectly resulting in
prevalence of hypothyroidism in women and men is
increased cardiac contractility and reduced systemic
2% and 0.1-0.2%, respectively .
vascular resistance .
One of the most important symptoms of
However there have been significant changes in
hypothyroidism is weight gain or inability to lose
weight  . Some studies have found a relationship
hypercholesterolemia, diastolic dysfunction, carotid
between thyroid function and body weight in a small
intimal and media thickness and endothelial derived
number of selected studies including obese
relaxation factor (nitric oxide) which are associated
individuals [4, 5] or those with thyroid disease . Some
with overt hypothyroidism . It is known that thyroid
studies [4, 5], but not all  have reported an association
diseases are often associated with cardiovascular
between thyroid function and body weight. Thyroid
morbidity, but the mechanisms that mediate this risk
hormones play an important role in synthesis,
are unclear. Metabolic syndrome (MetS) may be
metabolism and mobilization of lipids thus
potentially responsible for this. Low thyroid function
determining their effects on cholesterol synthesis .
may attenuate elevations in ALT in the context of
Received: 20/12/2017 DOI: 10.12816/0044767
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1867-1872
Depression symptoms and Risk of Incident Asthma in Adults
Hanan Showei H Fageeh 1 , Mohammed Meshal A Almeshal 2 , Saleh Fouad M Merza 3 ,
Musaad Saad S Albalood 4 , Nayef Muaazzi Saleh Alblowi 5 , Bahna Mohammed Bahna Alsahabi 6 ,
Abeer Abdalaziz Al Hatim 7 , Murad Ahmed Bahidan 8 , Lujain Jamal M Alfattany 9 ,
Shaher Shakir S Abdulrahim 10 , Ahmed Ali R. Alghamdi 11 , Hassan Hamadan N Aljohani 12
1- ER, East Jeddah Hospital , 2- Imam Muhammad ibn Saud Islamic University,
Service , East Jeddah Hospital , 4- Imam Muhammad ibn Saud Islamic University ,
5- General Physician, King Salman Armed Forces Hospital - North Western Region,
6- King Khalid University, 7- Al Maarefa College , 8- Yanbu General Hospital ,
9- King Abdulaziz University , 10- Jeddah University , 11- Alamal Hospital, Jeddah ,
12- Primary health care -Almuntazh Alsharqi, Hail
Background: Earlier studies have recommended that asthmatic patients regularly have comorbid depression;
nonetheless, temporal associations remain uncertain.
Objectives: To determine whether depression predicts asthma and, on the other hand, whether asthma expects
Methods: A literature search was conducted without language restrictions using Pubmed, Embase, Cochrane
and PsycINFO for studies published before April, 2017. Papers referenced by the obtained articles were
correspondingly reviewed. Only comparative prospective studies with reported risk estimates of the association
between depression and asthma were included. In order to examine whether one of these conditions was
predictive of the other, studies were excluded if enrolled participants had pre-existing depression or asthma. A
random effects model was used to calculate the pooled risk estimates for two outcomes: depression predicting
asthma and asthma predicting depression.
Results: Seven citations, derived from 8 cohort studies, met our inclusion criteria. Of these, six studies
reported that depression predicted incident adult-onset asthma, including 83,684 participants and 2,334
incident cases followed for 8 to 20 years. Conversely, two studies reported that asthma predicted incident
depression. These studies involved 25,566 participants and 2,655 incident cases followed for 10 and 20 years,
respectively. The pooled adjusted relative risks (RRs) of acquiring asthma associated with baseline depression
were 1.43 (95% CI, 1.281.61) (P<0.001). The adjusted RRs for acquiring depression associated with baseline
asthma was 1.23 (95% CI, 0.722.10) (P = 0.45).
Conclusions: Depression was associated with a 43% increased risk of developing adult-onset asthma.
However, asthma did not increase the risk of depression based on limited studies. Further prospective studies
confirming the true association between asthma and subsequent risk of depression are warranted.
Keywords: Depression, Asthma, Depression predicting asthma,Asthma predicting depression.
Depression and asthma are two highly
between depression and asthma (there were only
widespread chronic diseases worldwide, imposing
two investigating depression predicting asthma and
intolerable social and economic burdens on the
none examined asthma predicting depression).
public healthcare system [1,2]. Equally detrimental,
Since then, many well-designed prospective studies
asthma affects 300 million individuals worldwide
have been published [6-8], allowing for a more
, with increasing commonness in many countries
detailed analysis of the temporal relationship
. As both depression and asthma carry out
between these two disease.
substantial public health burdens, the association
Consequently, the purpose of this study was to
between these two conditions has attracted
attention over the past numerous decades.
predicts asthma and, on the other hand, whether
A number of prospective studies have evaluated
asthma predicts depression by conducting a meta-
the temporal relationship between asthma and
analysis of prospective studies.
depression; nonetheless, the outcomes were
indecisive. An earlier meta-analysis of prospective
MATERIALS AND METHODS
studies described a bidirectional relationship
A literature search was conducted without
amid psychosocial factors and atopic disorders.
language restrictions using Pubmed, Embase,
Nonetheless, this meta-analysis only involved
Cochrane and PsycINFO for studies published
studies published before 2007, and was lacking
before January, 2015. Papers referenced by the
studies which definitely address the relationship
obtained articles were also reviewed. Only
Received: 20/12/2017 DOI: 10.12816/0044768
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1873-1876
Emergency Management of Upper GI Variceal Bleeding
Zohair Radi Alghazal1, Abdulqader Ibrahim Susi2, Ruqeeya Ali Alshaikhnasser3,
Waad Suliman Alsaadi4, Feda Hassan Almahdi5, Atheer Eed Alotaibi6,
Maryam Baqer Aldubaisi7, Yaser Saeed Mohammad Sharif8
1- Dammam University, 2- Taibah University, 3- Dammam Medical Center,
4- Umm Alqura University, 5- Imam Abdulrahman Bin Faisal University,
6- King Khalid University, 7- Dammam Medical Complex, 8- Batterjee Medical College
Corresponding author: Zohair Radi Alghazal - Zohairalghazal@gmail.com - 0553068532
Background: Upper gastrointestinal bleeding is the most common gastrointestinal cause of admission in
emergency departments worldwide with about 10% inpatient mortality rate that has not decreased during the last
Aim: In this review, we aim to study the pathophysiology behind the development of upper gastrointestinal
bleeding, and explore the approach to its management in emergency situation.
Materials and Methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 2001, through February 2017. The following search terms were used: upper gastro intestinal
bleeding, variceal bleeding, emergency management of gastrointestinal hemorrhage, varices, esophageal
Results: Managing patients with bleeding varices must have two goals that should be considered: to stop the
bleeding, and to prevent rebleeding since 60% of patients will rebleed after the acute bleeding was stopped
leading to a mortality rate of 33%, unless adequately treated.
Conclusion: Bleeding varices are always considered urgent emergencies due to associated morbidity and
mortality. Moreover, bleeding varices can cause hemodynamic instability and end-organ failure. The most
important intervention is therapeutic endoscopy. Other approaches include vasoactive drugs, and prophylactic
antibiotics. After acute management of the bleeding, patients should undergo further evaluation and treatment to
prevent the recurrence of another bleeding.
Keywords: emergency management of gastrointestinal hemorrhage, varices, esophageal bleeding, upper gastro
intestinal bleeding, variceal bleeding.
About 150 per 100,000 persons every year suffer
techniques, emerge of drugs with vasoactive affects,
from upper gastrointestinal bleeding (UGIB),
endoscopy, and prophylactic antibiotics. When
making it a major health problem. UGIB is the most
managing cirrhotic patients with bleeding varices,
common gastrointestinal cause of admission in
there are two goals that must be considered: to stop
emergency departments worldwide with about 10%
the bleeding, and to prevent rebleeding. About 60%
inpatient mortality rate that has not decreased during
of patients will rebleed after the acute bleeding was
the last three decades, despite all improvements in
stopped with 33% mortality rate, unless it was
the medical field. Recent research reported a
treated adequately .
significant mortality rates following bleeding
(0.64%), compared to mortality after myocardial
infarction (0.77%), after adjustment for other
confounders. Hemorrhage from a bleeding varices is
· Data Sources and Search terms
a fatal outcome of cirrhosis, and thus a serious
We conducted this review using a comprehensive
search of MEDLINE, PubMed, and EMBASE,
Bleeding varices in cirrhotic patients have an
January 2001, through February 2017. The
overall mortality rate that ranges between 10-20%.
following search terms were used: upper gastro
Before 1980, mortality from varices was about 40%,
intestinal bleeding, variceal bleeding, emergency
but it has since decreased, especially with
management of gastrointestinal hemorrhage, varices,
improvements in the intensive care resuscitation
Received: 20/12/2017 DOI: 10.12816/0044769
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1877-1879
Anemia: its Prevalence, Causes, and Management
Afnan Shukri A Sharourou1, Mohamed Ahmed Hassan2, Mosay Berihu Teclebrhan3,
Hesham Mohammed Alsharif4, Ahmed Saeed alamoudi5, Hawra Mustafa alkhatem6,
Sukayna Adil Alhamad7, Tahani Saleem Alsinani8
1 Royal College of Surgeons in Ireland, 2 University of Medical Sciences and Technology,
3 Kharkiv National Medical University, 4 Taif University, 5 King Abdulaziz University,
6 Maternity and Child Hospital in Dammam, 7 Primary Health Care Qatif, 8 Batterjee Medical College
Corresponding author: Afnan Shukri A Sharourou - Afnan.email@example.com - 00966566677445
Background: Nutritional anemia or anemia due to dietary causes is the most common form, yet the easiest to
manage compared to other forms of anemia. Some of the most common nutritional deficiencies are iron,
cobalamin, folate, and also other elements like copper. Anemia due to diet is mostly asymptomatic in the initial
phase until the stores are depleted, which can take a few months to several years, depending upon the cause.
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: nutritional anemia, dietary anemia, iron
deficiency anemia, cobalamin deficiency, folic acid deficiency anemia, dietary anemia treatment
Aim of the work: In this study we aimed to understand about the different types of anemia caused as a result of
dietary deficiency. We will also briefly study about their presentation, pathophysiology, and treatment.
Conclusion: Various causes, presentations, and complications are associated with different types of nutritional
anemia, but they still are the easiest to treat and manage. Most cases are due to an underlying occult disorder rather
than simple dietary insufficiency, making diagnosis more difficult in some cases, and requiring thorough history
and investigations integration to reach an accurate diagnosis and treat the underlying cause.
Keywords: dietary anemia, iron deficiency anemia, cobalamin deficiency, folic acid deficiency anemia, dietary
anemia treatment, nutritional anemia.
Anemia is defined by WHO by a hemoglobin level
However, chronic diseases and other causes that
that is less than 13 g/dL in male adults, and less than
lead to decreased RBCs count, have been dramatically
12 g/dL in female adults. This definition is the most
increasing lately .
commonly used one in both clinical and research
settings. Anemia will lead to decreased capacity of
RBCs to carry oxygen, eventually causing significant
· Data Sources and search terms
morbidities and mortalities. Anemia presents initially
We conducted this review using a comprehensive
with non-specific symptoms like fatigue, weakness, or
search of MEDLINE, PubMed and EMBASE from
even impaired cognitive functions. Elderly with anemia
January 1987 to March 2017. The following search
are at a higher risk of hospitalization with higher
terms were used: nutritional anemia, dietary anemia,
mortality rates. Anemia can be present in up to 17% of
iron deficiency anemia, cobalamin deficiency, folic
congestive heart failure cases worsening capacity and
acid deficiency anemia, dietary anemia treatment.
survival significantly. In children anemia has been
The study was done after approval of ethical board
shown to cause a decline in psychomotor and cognitive
of King Abdulaziz university.
development. Moreover, the risks of preterm labor, low
birth weight, and maternal mortality, were all found to
· Data extraction
significantly increase with the presence of iron
Two reviewers have independently reviewed the
deficiency . To summarize, children, young women,
studies, abstracted data and disagreements were
pregnant women, and elderly have the highest risk of
resolved by consensus. Studies were evaluated for
morbidity and mortality associated with anemia. Other
quality and a review protocol was followed throughout.
important factors include racial and ethnic disparities;
African Americans have a 3-fold increase in the
prevalence of anemia when compared to whites. The
The most prevalent health concern worldwide is
most important cause of anemia is iron deficiency.
anemia, with varying prevalence between different
Received: 20/12/2017 DOI: 10.12816/0044770