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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1880-1886
An Assessment of Knowledge towards Complications of
Sickle Cell Disease among General Population in Jeddah City
Adilah Hamoud Alturaifi1, Nada Mohammed Alsharif1, Walaa Khalid Abulola1, Yasmen Taha
Maimani1, Ebtehag Faham Alsulami2, Abdulmajeed Aboud Alotaibi3, Rahaf Salah Osman Ahmad1
1Ibn Sina National College for Medical Studies, Jeddah, 2King Abdelaziz University, Jeddah,
3Umm Al-Qura University, Makkah, KSA
ABSTRACT
Background: Sickle cell disease (SCD) is an autosomal recessive disorder characterized by production of
abnormal hemoglobin S, and it is associated with high morbidity and mortality. The highest prevalence of
SCD in Saudi Arabia is in the Eastern province.
Objectives: To assess perceptions and the level of knowledge about SCD and to study factors that may
affect them among general population in Jeddah city, Saudi Arabia.
Methods: A self-administered questionnaire was distributed among general population residing in Jeddah
city, Saudi Arabia. The questionnaire consisted of two sections: (1) socio-demographic information and
previous experience with SCD and (2) knowledge about SCD and its complications, which was measured by
20 closed-ended questions. Results: A total of 424 subjectscompleted the questionnaires and participated in
the study. More than half (51.4%) of the participants showed good level of knowledge about SCD and its
complications. Sex, education level, and previous experience with SCD child had significant association with
the level of knowledge (p<0.05). The majority of participants with good level of knowledge were females
(86.2%) and at the level of university education (84.4%). Furthermore, all subjects (100%) who had previous
experience with SCD child showed good level of knowledge.
Conclusion: A moderate level of awareness regarding SCD and its complications was found in our study
sample. Educational programs should target the male population, and emphasize the nature of inheritance of
the common blood diseases and their complications.
Keywords: knowledge; survey; perceptions; sickle cell disease; Saudi Arabia.
INTRODUCTION
Sickle cell disease (SCD) is a hemolytic
In
addition,
Adewoyin
et
al.(7)
anemia characterized by abnormally shaped
demonstrated moderate level of public health
(sickle) red blood cells (RBCs), which are
knowledge regarding SCD in Nigeria. In the
removed from the circulation and destroyed at
Middle East, Al Arrayed and Al Hajeri(8)
increased rates leading to anemia(1). Abnormality
reported a good level of knowledge about SCD,
in RBCs shape is mainly attributed to the presence
and a wide acceptance and appreciation of SCD
of hemoglobin S, which, when deoxygenated,
prevention campaigns among the public in
becomes relatively insoluble and forms aggregates
Bahrain.
with other hemoglobin molecules within the
Recently, Saudi Arabia has been reported
RBCs(2). A point mutation in the gene coding the
to have an increasing prevalence of SCD. The
chain of the hemoglobin molecule results in a
carrier status for SCD ranged from 2% to 27%,
single amino acid substitution (valine for glutamic
and up to 1.4% had SCD in Saudi Arabia(9). In
acid), which leads to hemoglobin S. Sickle cell
addition, the prevalence of consanguinity ranges
disease is one of the most commongenetically
from about60% in Saudi Arabia up to 90% in
inherited diseases affecting mainly African
some Bedouin communities(10). Therefore, the
Americans(3). In addition, it is a prevalent disorder
current study was carried out to assess perceptions
among those from Mediterranean area like
and level of knowledge about SCD and its
Turkey, and the Arabian Peninsula(4).
complications and to study factors that may affect
Regarding SCD treatment, routine general
them among general population in Jeddah city,
prophylactic and corrective measures have been
Saudi Arabia.
associated with marked improvement in life
expectancy and quality of life among sickle cell
METHODS
disease patients in developed nations(5),which
Study design:
points to the importance of providing the public
Questionnaire-based cross-sectional study.
with proper information on SCD. Early
Inclusion and exclusion criteria
community-based surveys conducted on African
We includedadult, male and female,Saudi and
Americans in large urban areas demonstrated
non-Saudi,residents of Jeddah, Saudi Arabia.
limited awareness of SCD in these communities(6).
1880
Received: 20/12/2017 DOI: 10.12816/0044836
Accepted: 30/12/2017
c:\work\Jor\vol7011_2
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1887-1890
Hair loss among Saudi Females, Taif University, Taif, Saudi Arabia
Alaa Daif Allah Althobaiti 1*, Ali Hassan Jaber Alzahrani 2, Rawan Nasser M.Alhunaki 3, Haidar
Mohammed Alshamrani 4, Ibtihal Abdulrahman Malawi 4
1Collage of Medicine, Taif University, Taif , 2King Abdulaziz University Rabigh Branch,
3Almaarefa Colleges, Riyadh, 4Umm Al Qura University, Makkah , Saudi Arabia
Corresponding Author: Alaa Daif Allah Althobaiti, Email: looloo1597@hotmail.com
ABSTRACT
Background: the female pattern hair loss is the most common cause of hair loss in female, which is
androgenic pattern, medical treatment such as anti-androgenic therapy and topical preparation may simply
arrest progression of female pattern hair loss or in some women stimulate partial growth of hair, but the
response is slow. This study aimed to determine the most common causes of hair loss among female with
regard to the age, the effect of some drugs, balanced diet, average amount of hair loss per day.
Objectives: this study aimed to determine the most common causes of hair loss among Saudi females.
Materials and method: this was a cross sectional study of the women aged 20-50 years designed in a
questionnaire form involved series of questions with multiple choices answers. It was conducted in Saudi
Arabia in October 2017. The data entry were done by using Microsoft Excel, while the analysis was done by
using SPSS version 23 and we used it in test correlation coefficient Spearman with measuring the mean
value for all questions. Results: data were analyzed via using SPSS program, version 23 and we used it in
test correlation Coefficient Spearman between Q1 AND Q9=0.146 week positive and p-value=.087 >0.05 we
didn't reject the null hypothesis. Correlation Coefficient Spearman Q23 and Q29=.008 no relation and p-
value=0.927>0.05 we didn't reject the null hypothesis. In Q3 the mean was =6.83 and Q7; the mean was
=2.50. Conclusion: in KSA we found the unbalanced diet to be the most effective factor that leads to hair
loss among out sample size. In the present study we need to educate the population about the importance of
balanced diet for maintaining of healthy hair and skin.
Keywords: female pattern hair loss, causes, diet, risk factor.
INTRODUCTION
which became now the major complains in the
Telogen effluvium is a non-scarring alopecia
clinics, sometimes it is related directly with the
described as a widespread shedding of telogen
club hair from the scalp. Most of the cases initiate
advanced age which led to create a lot of
the symptoms between 812 weeks after the
fabrications for the cultivation of hair or
exposure of any trigger events, for examples:
shampoos and creams. On the other hand, the
pregnancy, major sickness or after a complicated
abnormal shedding may be due to serious diseases
surgery, most of the cases improved within 36
like: FPHL, acute and chronic telogen effluvium,
months. And its diagnosis is often retrospective
alopecia areata, anagen effluvium, and cicatricial
diagnosis (1).
alopecias (2,5) . The term FPHL is preferred to
Hair shedding is, therefore, a common
androgenetic alopecia as the majority of women
consequence of the normal hair cycle. The amount
with FPHL do not have increased levels of male
of hairs that are shed depends on several internal
hormones, nor other signs of increased androgen
and external factors and the conscious perception
effect, and do not respond to anti-androgens with
of hair shedding can vary by individual. It is
dramatic hair regrowth (6).Female pattern hair loss
logical to think that the amount of shedding
(FPHL), characterized by a diffused reduction in
should also depend on the total hair density and
hair thickness, is the most common cause of hair
that women with thin hair and reduced hair
loss in women and affects >50% of women at the
density, as for instance women with advanced
age of 80 (7). Furthermore, an epidemiological
female pattern hair loss (FPHL), shed less than
survey in northern China suggested that the
women with early FPHL or women with normal
incidence was 6.0% in females, lower than that in
hair density, whether or not active hair loss is
Western countries (8).
taking place. However, there are no specific
However, due to the large population in China,
studies on hair shedding in women with severe
the number of women with FPHL in China is
FPHL. Hair shedding could be normal or
high. Although it is a mild dermatological
abnormal. Most of the women think that the
disorder, psychologists and dermatologists have
normal amount of hair shedding is abnormal
observed that even clinically imperceptible hair
loss is capable of damaging the quality of life
1887
Received: 20/12/2017 DOI: 10.12816/0044837
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1891-1893
Public Awareness of Systemic Lupus Erythematosus in
Al-Dammam City in Saudi Arabia
Mohammed Difallah Alharbi1, Bander Owaidh Aljohani2, Zahra Naji Alaithan3, Saud Khaild
Alsamadani4, Sultan Abdullah Alnefaie4, Abdulaziz Ibrahim Alshabibi5, , Bayan S Alqahtany5,
Abdulmalik Abdulaziz Aldeheem5, Yasser A Alrumih5, Abdullah Tawfiq Aldoaje6, Mohammed
Muthyib Almuawi6, Faisal Ali Alqahtani7, Faisal Ali Almesned8, Mohammed Ali Alzubaidi9,
Mohammed Saad Alotaibi10, Marwan Saleh Al solmi10, Mutlag Jaual Alqahtani11, Hussain Ali
Busaleh12, Abdullah Abdulkareem Alsubaie13
1Al-imam Mohammed Ibn Saud University, 2Kaakya Health Center, 3Imam Abdulrahman bin Faisal
University, 4King Faisal Hospital Makkah, 5King Saud University, 6Ibn Sina National Collage, 7Aljiser
Primary Health Care Center, 8Qassim University, 9Security Forces Specialists Jeddah, 10Umm Alquraa
University, 11Jubail Hospital, 12University of Science and Technology, 13Prince Saud bin Jalloway Hospital
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is an autoimmune disease where the body's immune
system attacks its own healthy tissue. It can affect many organs such as skin, joints, brain, kidneys and other
organs.
Objectives: to evaluate the knowledge toward Systemic Lupus Erythematosus (SLE) among citizens in Al-
Dammam city.
Methods: a questionnaire-based quantitative cross-sectional study which focuses on determining the
knowledge of Systemic lupus erythematosus in Al-Dammam city.
Results: 240 participants filled the surveys, 130 participants (54%) have no idea about SLE. The majority of
respondents had no clear idea regarding treatment and complications of the disease. 32% respondents had idea
that SLE is more prevalent among females. In fact, this disorder is reported more prevalent in women.
Conclusion: this study indicated that the public have low awareness with some misconception regarding the
SLE. The awareness campaigns are needed to increase the awareness about SLE which will be helpful to
educate the public about its symptoms and methods of treatments.
Keywords: autoimmune diseases, Lupus Erythematosus, SLE.
INTRODUCTION
SLE awareness and management in Saudi
Systemic lupus erythematosus (SLE), also
Arabia. Data were collected from public mall
known simply as lupus, is an autoimmune disease in
(Al-Dammam)
using
a
self-administered
which the body's immune system mistakenly attacks
questionnaire. Data were collected from 240
healthy tissue in many parts of the body. Symptoms
participants. The study was done after
vary between people and may be mild to
approval of ethical board of Al-imam
severe. Common symptoms include painful and
Mohammed Ibn Saud university.
swollen joints, fever, chest pain, hair loss, mouth
ulcers, swollen lymph nodes, feeling tired, and a
Study Settings
red rash which is most commonly on the face. Often
The target population was males and
there are periods of illness, called flares, and periods
females came to the main gate of the public mall.
of remission during which there are few symptoms.
Exclusion criteria are; age less than 20 years old,
Generally, public awareness on SLE is too poor
cannot read Arabic, non-Saudis. Participants
(1).Study was done found that only 34% of the
were randomly selected and asked to fill out a
population was aware of the condition among the
questionnaire.
Portuguese (2). Increases in awareness level of SLE
will help in diagnosing this disease earlier and make
Statistical analysis
clear plan to manage this disorder. This study was
A questionnaire written in Arabic was face
carried out to assess the awareness level about SLE
validated by showing it to professors of researches
among the public in Al-Dammam city (Saudi
in Al-Dammam University and modifications were
Arabia).
made based on their feedback. A copy of this
questionnaire was administered to the participants;
METHODOLOGY
along with the questionnaire was a consent form.
Study Design
The questionnaire included closed ended questions
A quantitative cross-sectional study
and multiple choice questions.
which focused on determining the knowledge of
1891
Received: 20/12/2017 DOI: 10.12816/0044865
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1894-1897
Anterior Cruciate Ligament Injury and Management
Zainab Redaa Alghanim1, Abdulrahman Muslim Allogmani2, Mohammad Ali Karbouji2,
Abdulrahman Mohammed Abdulrahman Albouk3, Khaled Mahmoud Ghabban2,
Mohammed Moaed Alghamdi4, Eyaad T Ghallab5, Rashed Ibrahim Alqunaian6.
1 Imam Abdulrahaman Bin Faisal University, 2 Taibah University, 3 King Fahad Hospital-Almadinah
Almonawra, 4 Ibn Sina National College, 5 King Abdullah Medical Complex Jeddah, 6 imam abdulrahman alfaisal hospital
Corresponding Author: Zainab Redaa Alghanim email: Zainab.R.Alghanim@Gmail.Com mobile: 0501703752
ABSTRACT
Background: Anterior cruciate ligament is the most common knee ligament injury, and they are associated with
several long term clinical consequences such as chondral lesions, meniscal tears, and early onset osteoarthritis. The
injury can occur with direct contact or without as well. The diagnosis is made with history, special physical
examination tests, and using imaging with MRI.
Aim of the work: this study was aimed to understand the mechanism behind anterior cruciate ligament injury, its
diagnosis, and methods of management.
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE
from January 1971 to March 2017. The following search terms were used: Anterior cruciate ligament anatomy,
knee ligament injury mechanism, diagnosis of knee ligament injury, management of anterior cruciate ligament
injury.
Conclusion: Anterior cruciate ligament injury is a very common injury and requires quick diagnosis to control
pain, further deterioration, and avoid long term morbidity. Management includes from conservative to surgical
repair and reconstruction.
Keywords: knee ligament injury, sport injury, ligament tear repair, management of anterior cruciate ligament tear.
INTRODUCTION
the treatment of choice for ACL injuries, especially in
Both ligamentous and neuromuscular joints
cases where soon return to high-level activities is
restraints contribute (passively, and actively,
important, like athletes and young individuals.
respectively) in maintaining the dynamic stability of
However, there has been some recent approaches to
the knee. Of these ligaments, the anterior cruciate
return to the use of ACL repairs. This has been mainly
ligament (ACL) is considered the main passive
to the development of novel techniques in tissue
structure that maintains the stability of the knee with
engineering and regenerative medicine that use growth
the femur and the tibia. However, the anterior cruciate
factors, and stem cells. The use of these techniques has
ligament is also the most usually damaged ligament
provided promising results and led to more focus in
during sports and other activities causing devastating
research on ACL repair [2].
sequelae, affecting the movement of the joint, the
strength of muscles, and physical functions, and
METHODOLOGY
leading to effusion of the joint. This will sometimes
· Data Sources and search terms
cause the absence of the patients from a whole season
We conducted this review using a comprehensive
or even more from the sport. Other than immediate
search of MEDLINE, PubMed and EMBASE from
sequelae, injuries of ACL are also associated with long
January 1971 to March 2017. The following search
term complications that include chondral lesions, post-
terms were used: Anterior cruciate ligament anatomy,
traumatic osteoarthritis (OA), and meniscal tears [1].
knee ligament injury mechanism, diagnosis of knee
In addition to its high liability to injury, ACL is
ligament injury, management of anterior cruciate
considered to have a poor healing ability even after
ligament injury
surgical interventions with sutures. The high failure
· Data extraction
rates following suture repair led to the stoppage of its
Two reviewers have independently reviewed the
use, especially after the introduction of ACL
studies, abstracted data and disagreements were
reconstruction. Since then, reconstruction have been
resolved by consensus. Studies were evaluated for
1894
Received: 20/12/2017 DOI: 10.12816/0044838
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1898-1903
Rheumatoid Arthritis, Pathophysiology and Management
Mohannad Mobarak Omar Badghaish1, Ghofran Noor Mohammad Qorban2, Abdulmohsen Shawan
Albaqami3, Ameera Ahmad Nemer4, Aisha Jamal Alali5, Rawan Fouad Hassan Al Yaqoub6, Homoud
Abdulaziz Alshamrani7, Omar Hasan Badahman1, Rahma Abdulkarim Ansaif8, Metab Ali Alasmari9,
Arwa Yahya Alghamdi4, Hussain Ahmad Saud Alshareef10, Alanoud Mohammed Aljadeed6, Ayman
Ahmed Almohammed11, Doaa Mohammad Filmban12, Abdulrahman Saleh Alaql13
1 King Abdulaziz University, 2 King Abdulaziz University Hospital, 3 Imam Muhammad Ibn Saud Islamic
University, 4 Immam Abdulrahman Faisal University, 5 Arabian Gulf University, 6 Ibn Sina National College,
7 Primary Health Care Center Riyadh, 8 Alexandria University, 9 Gizan Militarily Hospital,
10 King Fahad Hospital, Madinah, 11 King Faisal University, 12 Al Noor Specialist Hospital,
13 Al Adeel Primary Health Care Center
Corresponding author: Mohannad Mobarak Omar Badghaish
email: Dr.mbadghaish@gmail.com mobile:0565544088
ABSTRACT
Introduction: Rheumatoid arthritis is considered one of the most common, and particularly attacks the joint
causing significant individual and community burden, and present with articular as well as extra articular
manifestation. Treatment modalities of rheumatoid arthritis have dramatically improved in recent years,
significantly decreasing long-term auricular and extra-auricular complications.
Aim of the work: this review was aimed to study the pathophysiology, clinical picture, and management of
rheumatoid arthritis, with focus on the newer modalities.
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: rheumatoid arthritis, chronic
inflammatory disorders, genetic of rheumatoid arthritis, management of rheumatoid arthritis, DMARD, biological
agents
Conclusion: The newer modality of treatment must include disease-modifying antirheumatic drug (DMARDs)
which must be started as early as possible. Combining DMARDs with corticosteroids will result in significantly
better outcomes than monotherapy with any DMARD, and decrease long term morbidity associated with this
condition.
Keywords: chronic inflammatory disorders, management of rheumatoid arthritis, DMARD, biological agents,
rheumatoid arthritis
INTRODUCTION
musculoskeletal system, and leading to physical
Among chronic inflammatory diseases, rheumatoid
functions decline, increased risk of long-term
arthritis is considered one of the most common, and
complications, and decreased quality of life. On the
particularly attacks the joint causing significant
other hand, the community will also be affected by
individual and community burden. However, it can
both the high medical expenses of management, and
also attack other organs and cause extra-articular
the reduced capacity of community members from the
manifestations. These extra-articular manifestations
functional disability. To decrease this burden of the
include vasculitis, pulmonary involvement, and
disease, efforts aim at early diagnosis, proper
rheumatic nodules. Treatment modalities of
management, and continuously creating new treatment
rheumatoid arthritis have dramatically improved in
modalities [2].
recent years, with introduction of new management
METHODOLOGY
guidelines and diagnostic criteria. This revolution in
· Data Sources and Search terms
management has caused significant decrease in long-
We conducted this review using a comprehensive
term auricular and extra-auricular complications [1].
search of MEDLINE, PubMed, and EMBASE,
Individuals with rheumatoid arthritis will suffer from
January 1988, through February 2017. The following
significant comorbidities resulting from defects of the
search terms were used: rheumatoid arthritis, chronic
1898
Received: 20/12/2017 DOI: 10.12816/0044839
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1904-1906
Unusual Presentation of Nasal Myiasis
Mohammed A Aljuaid, Jehad A Alzahrani, Moad B Basfar, Hisham A Essa
College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
Corresponding author: Moad B Basfar, email: moadbasfar@icloud.com
SUMMARY
This is a 25 years old male who have been diagnosed with asthma recently, presented to the ER with a
clinical picture of acute respiratory distress. Mechanical ventilation was required due to severe hypoxia
along with full asthma management. Patient status remain static despite treatment. Initial workup did not
show any evidence pointing towards a specific underlying etiology of this refractory asthma. On second day
of admission, worms were noted emerging from his nose, parasitology report confirm the diagnosis of
myiasis. Patient respond dramatically to ivermectin and metronidazole and was discharged without any
complication.
Keywords: Unusual Presentation, Nasal Myiasis.
BACKGROUND
Myiasis is the parasitic infestation of the body of a
Detailed history was obtained from his friend who
live mammal by fly larvae (maggots) that grow inside
were at the scene with him when he experienced the
the host while feeding on its tissue. Although flies are
sudden attack (later confirmed by the patient) . He is
most commonly attracted to open wounds and urine or
known asthmatic on Ventolin PRN. Without any
feces-soaked fur, some species (including the most
warning he experienced sudden onset of shortness of
common myiatic flies (such as the common housefly)
breath that limited him from speaking. He is otherwise
as vector agents for their parasitic larvae.
healthy and compliant with treatment. Other review of
Because some animals (particularly domestic
system is unremarkable. No prior similar attack before
animals) cannot react as effectively as humans to the
or any previous admission. No family history of
causes and effects of myiasis, such infestations
cardiac disease. He is not known to be on any
present with severe and continuing problem for
recreational drugs nor smoking. He lives with his
livestock industries worldwide, causing severe
family in Taif city with good socioeconomic status.
economic losses where they are not mitigated by
No recent travel to endemic areas or any known
human action[1].
allergy.
Although typically a far greater issue for animals,
myiasis is also a relatively frequent affliction of
Rest of examination was insignificant except for
humans in rural tropical regions where myiatic flies
central cyanosis and silent chest. No cutaneous lesion
thrive, and often may require medical attention to
or draining wound were appreciated.
surgically remove the parasites[2].
Differential Diagnosis
Case presentation
Asthma exacerbation
The story is about a 25 years old Saudi college
Anaphylaxis
student who was brought in by the ambulance to
Arrhythmia
emergency room of King Faisal Hospital at Taif city
Pneumothorax
of Saudi Arabia due sudden attack of shortness of
Allergic bronchopulmonary aspergillosis (ABPA)
breath. Initial assessment of the patient reveals an
Drug overdose
anxious patient in a respiratory distress with inability
Intracranial hemorrhage
to talk in phrases. Ventolin started empirically but
Investigation
shows no improvements. Within minutes he started
Routine lab work done along with ECG, ABG,
deteriorating and seizing in form of generalized tonic
Brain CT and CXR. Initial lab showed normal WBC
clonic. Vitals signs were as follows: T : 37C, BP
but with lymphocytosis and eosinophilia. Other
:161/100, HR :144, O2 sat : 50% on room air and
parameters were normal. ABG picture was consistent
RR: 55. Immediately he was intubated and started on
with respiratory acidosis and severe hypoxemia. CXR
mechanical ventilation.
showed only hyperinflated chest and flattened
1904
Received: 20/12/2017 DOI: 10.12816/0044840
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1907-1917
Knowledge, Attitude and Practice Related to Health Impact of Performance-
Enhancing Drugs among the Male Students in Qassim University
Noha Dekhail M. Aldekhail, Abeer Ali Alkredes, Arwa Sulaiman Alkabas, Aseel Ali Al- Saeed
,Mashael Abdullah Alghaidani ,Renad Ali AL-Sohaibani , Sahar Mohammed Aljomaiah
Faculty of Medicine, Qassim University, Saudi Arabia
ABSTRACT
Background: Performance-Enhancing Drugs ( PEDs ) are used by young adults to enhance physical performance
and appearance. There are many medical problems associated with Performance-Enhancing Drugs .
Aim of the work: this study aimed to estimate knowledge, attitudes and practices about the hazards of PEDs
among young adults (18-28 years old) in Qassim University. Method: this was a descriptive cross-sectional
analytical study carried out among male students at Qassim University, Kingdom of Saudi Arabia during 2014-
2015. A self-administered questionnaire was completed from 134 male students in three colleges, one medical
and two non-medicals. Results: prevalence of use in the medical students were 66.7 who were previously used
AS and the half (33.3%) in non-medical students, but the current use among medical student was 16.7%, less
than non-medical (83.3%). Regarding the source of using PEDs , the highest percentage in the medical students
from friends, and the doctors in non-medical students. The prevalence of knowledge of medical students who
know about side effect of using PEDs was 62,1 % more than non-medical (37,9 %). The majority of medical
student recognized liver disease (61,9%), infertility (60%), gynecomastia (65%), shrinking testicle (62.5%) and
hormonal disturbance (37.1%) compared to non-medical who knew about liver disease (38.1%), infertility (40%),
gynecomastia (35%), shrinking testicle (37,5%) and hormonal disturbance(26,9%). Medical students showed
positive attitude towards the use of PEDs (31.8%) which showed less than non-medical students (68.2%). As
(61.1%) of non-medical believed the PEDs were responsible for improvement their performance conversely,
38.9% of medical students believed in that improvement. Conclusion, the non-medical students knew about the
benefits of using PEDs for performance enhancement (47%) more than medical students (24%), thus non-medical
students believed of enhancing their performance by PEDs more than the medical students. The medical and non-
medical students who used PEDs had exposed to their side effects therefore, we should pay more attention to
educate those about them more.
Keywords: PEDs , Al-Qassim University, knowledge, attitude, practice, KSA.
INTRODUCTION
Since this type of drugs become widespread
Drug use and abuse is a serious problem that
beside it kills the health of our society, estimation the
affects the health of adolescents and young adults.
knowledge, attitude and pattern of use regarding
There is tendency of this group to improve and
health hazards is prefect idea of protection that we
promote their performance in a harmful way by
will provide [2]. The studied group ware considered
consuming a lot of Performance-Enhancing Drugs (
the most important main power in the society and it is
PEDs ). PEDs have serious side effects by
important to be protected against this health problem.
influencing all over the body systems in a direct and
indirect manner. Other substances as vitamin and
Literature Review
protein supplements are considered as good
Performance-enhancing drugs considered as a
enhancing medications, they could be extracted from
wide variety of drugs intended for the aim of
diet before decide to take medications. The PEDs
promoting the activity, increasing the endurance and
could be given by some cases of health diminution to
alertness, strengthening the muscular power of the
improve the health quality. The abuse of PEDs by
users and to perform beyond ability. Many users tend
healthy adults is not acceptable regarding its harmful
to use them in the hope of correcting their body
effects on body, which include the heart, liver,
dissatisfaction
and
social
recognition
[3
].
growth retardation, and hormonal disturbances by
Since the winning competitions and seeking for
competing
the
normal
hormonal
good appearance in addition to peer pressure, the
steroids, virilisation, hirsutism and other men-like
incidence of use of Performance-enhancing drugs has
characters and other important side effects [1].
increase over the past years regardless of their side
effects which might be very serious leading to death
1907
Received: 20/12/2017 DOI: 10.12816/0044841
Accepted: 30/12/2017
c:\work\Jor\vol7011_8
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1918-1920
Contact Lens-related Complications
Ashwaq Y. Asiri, Atheer Eed Alotaibi , Yara Mofarih Assiri , Bayan Sultan Aljobran,
Wafa Daifallah Alshehri
Medical students - King Khalid University
ABSTRACT
Aim of the work: the contact lenses are widely used for management of refractive errors and cosmetic purposes as
well. Their complications are rare and usually caused by in appropriate maintenance of the lens and bad habits for
wearing too long. Methodology: all the English data related to the subjects were collected after reviewing Pubmed,
SCOPUS, ScienceDirect and other search engines. Results: this review showed the most common complications,
risk factors and management of diseases related to contact lens wearing. Eachproblemwas described by its
symptoms, risk factors and management as well as prognosis. Conclusion: the selection of proper lens and
education about the lens care system is efficient for reducing the complications related to contact lens.
Keywords: contact lens, complications, discomfort, ulcer, dryness, keratitis.
INTRODUCTION
environmental factors and contact lens related factors.
Contact lens have been commonly used for
The environmental factors include humidity, high or
management of refractive errors or cosmetic purposes
cold temperature, dry eye, computer usage, light and
(1). Contact lenses resemble a profitable industry
medications (15, 16). The causes related to contact lens
which is growing by 6.7% every year and are
are the design of the lens, wearing times, material
expected to reach about 12,476.3 million US dollars
including water content and lubricity of the lens(17).
by the year 2020 (2, 3).The prescription of contact
The management is based on providing comfortable
lenses is based on management of the simple or
daily wearing time and using lens care system or
massive errors that can't be managed using
using daily disposable lens and lubricating drops(18,
eyeglasses including irregular cornea, anisometropia,
19).
and keratoconus(4-6). Also, they can be used for - Contact Lens-related ulcer
treatment of epithelial defect, dry eye of Sjogren or
Peripheral ulcer:
Stevens-Johanson syndrome as well as post refractive
This type is categorized by excavation and infiltration
surgery rehabilitation(7-9).Furthermore, the contact
of the epithelium with intact Bowman layer which is
lens could lessen the activities restrictions, improve
different from corneal ulcers and they could be
the life quality and provide better appearance (10). But,
differentiated using clinical features. It is associated
they can cause many complications that could cause
with injection of the conjunctiva, focal infiltration
disappointment for the patients that could force them
located at the peripheral cornea(20). It is more
to choose other possible modalities (11).
common with bacterial toxins and inflammatory
This review provided an important issue related to
diseases and is significantly associated with extended
contact lens complications and how to manage them
wear lenses especially silicone hydrogel lenses (21,
properly.
22).The management could spontaneously regressed
after discontinuation of contact lens wearing (23).
Complications of contact lens
- Keratitis
- Discomfort of contact lens:
Microbial Keratitis
The contact lens discomfort is defined as
It is an active inflammation of the cornea that
intermittent or continuous sensation from wearing
associated with viruses, bacteria or even parasites
lens that could be associated with visual disturbance
caused by contact lens wear (24). Also, contamination,
or ocular surface stainingorconjunctivalhyperemia(12,
trauma and hypoxia are risk factors for microbial
13). This discomfort is caused by decreased
keratitis (25, 26).
compatibility between the eye and the contact lens
Proper lens care could prevent infectious
thus could result in cessation of wearing contact lens
keratitis,while other severe types that cause corneal
or at least lessening the wearing time or even
perforation or scleritis can be managed either with
cessation of contact lens wear(14).
medical treatments or surgical management (27, 28).
Two factors are associated with increasing the
Acanthamoeba Keratitis
incidence of contact lens discomfort including
It is an infection of the eye principally caused by
protozoa from contaminated lens that could threaten
1918
Received: 20/12/2017 DOI: 10.12816/0044842
Accepted: 30/12/2017
c:\work\Jor\vol7011_9
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1921-1924
Relationship between Helicobacter Pylori, Chronic Idiopathic
Urticaria and Atopic Dermatitis
Areej Misfer Albisher1, Manal Hassan Alharbi1, Mohammed Misfer Albisher 2
1- Alfaisal University, 2- King Saud University
Corresponding author: Areej Albeshr <areejmalbeshr@gmail.com>
ABSTRACT
Background: Helicobacter pylori (H. pylori) is the microorganism responsible for the most frequent and
persistent bacterial infection worldwide. irolyp.H infection affects nearly half of the world's population. In
the developing countries, the prevalence of infection is as high as 90%, whereas in the developed countries,
excluding Japan, the prevalence is below 40% (1). An association between iro olyp.H infection and skin
diseases such as chronic idiopathic urticaria and atopic dermatitis has been suggested (2).
Aim of the work: this review aimed to focus on the relationship between Helicobacter pylori, chronic
idiopathic urticaria and atopic dermatitis. This association was reviewed in the following lines.
Methodology: we used scientific websites such as PubMed, Google Scholar and Research Gate to get
related articles about this subject. Results: several studies have reported the presence of H. pylori DNA in
environmental water sources. Diagnostic tests are usually divided into invasive (endoscopic-based) and
noninvasive methods. Using proton-pump inhibitors (PPIs) in combination with several antibiotics such as
amoxicillin plus clarithromycin or metronidazole have been considered as the first-line treatment.
Conclusion: H. pylori has a great prevalence among world's population. H. pylori infection could play a role
in the pathogenesis of a variety of skin diseases.
Keywords: H.pylori, urticaria, atopic dermatitis.
INTRODUCTION
METHODOLOGY
Helicobacter pylori (H. pylori) is a spiral-shaped
We used scientific websites such as PubMed,
microaerophilic gram-negative bacterium that
Google Scholar and Research Gate to get related
colonizes the gastric mucosa and induces a strong
articles about this subject. The research process
inflammatory response with release of various
involved specific keywords "correlation between H.
bacterial and host-dependent cytotoxic substances
pylori infection and urticarial, correlation between
(1-3). Epidemiological and experimental data had
H. pylori infection and atopic dermatitis, correlation
pointed to a strong relation of H. pylori infection
between H. pylori infection and skin diseases and
with the development of many extragastric
complication of H. pylori infection " to find more
diseases, such as cardiovascular, immunologic and
articles on the subject. We were more concerned
some skin diseases (4).
about English published articles only which
Most infections are probably acquired in
published from 1995 to 2017.
childhood, but geographic area, age, race,
socioeconomic status and hygiene seem to play
H. pylori epidemiology, sources, diagnosis,
roles in the prevalence of Helicobacter pylori.
treatment and complications
Higher rates of infection tend to occur at a
Helicobacter
pylori (H.
pylori)
is
the
younger age in the developing countries compared
microorganism responsible for the most frequent
to the developed countries and in regions
and persistent bacterial infection worldwide. H.
characterized by lower socioeconomic status and
pylori infection affects nearly half of the world's
higher density living (5). Since Helicobacter
population. In the developing countries, the
pylori (H. pylori) identification in 1983, an
prevalence of infection is as high as 90%, whereas
increasing amount of knowledge has collected, with
in developed countries, excluding Japan, the
this pathogen having been directly involved in the
prevalence is below 40% (2).
pathogenesis of several dermatological diseases (6).
Several studies have reported the presence of H.
An association between H. pylori infection and skin
pylori DNA in environmental water sources (7-9), but
diseases such as chronic idiopathic urticaria and
this probably reflects contamination with either
atopic dermatitis has been suggested (2).
naked DNA or dead H. pylori organisms. Spread
This review concerned with the association
via fecal contaminants is supported by the
between H. pylori infection and occurrence of skin
occurrence
of
H.pylori infections
among
diseases especially urticarial and atopic dermatitis.
institutionalized young people during outbreaks of
gastroenteritis (10).
1921
Received: 20/12/2017 DOI: 10.12816/0044843
Accepted: 30/12/2017
c:\work\Jor\vol7011_10
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1925-1928
Consanguinity between Parents and Risk of Epilepsy among
Children in Northern Saudi Arabia
Yasir Wadi Alanazi1, Nagah Mohamed Abo El-fetoh2, Ibrahim Meqbel Alanazi1,
Ahmad Mohammed Masarit3, Njood Waleed Nazer4, Sulafa Taher Sindi4,
Muneera Abdulkarim Aldaham1, Manal Nashi Alshammari1, Nouf Saad Alanazi1,
Asrar Ali Jabrah3, Mohammed Mahmoud Alkhayr5, Hisham Hamad Alameer6
1 Faculty of Medicine, Northern Border University, 2 Community Medicine Department,
Faculty of Medicine, Sohag University, Sohag, Egypt And Northern Border University, Arar,
3Primary Health Care Center, Jeddah, 4 King Abdulaziz University (KAU), Jeddah,
5 King Khaled University, Riyadh, 6 University of Debrecen, Hungary
ABSTRACT
Background: Epilepsy is one of the most common neurological disorders in childhood. There are various risk
factors that could lead to epilepsy. However, a few studies have shown that there is a strong link between
epilepsy and consanguinity. Further, population studies revealed an increased familial clustering of epilepsy
among first degree and to a lesser extent second degree relatives. Aim of the work: This study was conducted
to determine the prevalence of epilepsy among school children and adolescents (6-18 years) in Northern Saudi
Arabia and consanguinity between parents. Methods: A cross-sectional study was conducted among a sample
of students aged 618 years in all primary, preparatory, and secondary schools in Northern Saudi Arabia, KSA
during the academic year 2016-2017. Parents of the studied cases were given a predesigned and pretested
questionnaire to collect the relevant data on presence of physicians diagnosed epilepsy, consanguinity between
parents and family history of epilepsy. Results: Consanguinity between parents was significantly associated
with the development of epilepsy where 59.1% of epilepsy patients who participated in the current study had
parents who were cousins and 13.6% were non-relatives of the same family and only 22.7% of cases had no
relation between their parents (p=0.000). Family history of epilepsy was significantly associated with the
development of it where 68.2% of epilepsy patients who participated in the current study had positive family
history, while about half of them (31.8%) had negative family history (p=0.000). Conclusion: Consanguinity
between parents was significantly associated with the development of epilepsy in Northern Saudi Arabia.
Decision makers must regulate effective health education sessions to aware the public about consanguinity
between parents as a significant risk factor of the epilepsy.
Keywords: Consanguinity between parents, Risk factor, Epilepsy, Northern Saudi Arabia
INTRODUCTION
It is not associated with a high mortality rate [9].
Consanguinity is a common marital habit
Several types of childhood epilepsy, such as benign
practiced in many developing countries. It is
focal childhood epilepsy, childhood absence
defined as unions contracted between persons
epilepsy, and juvenile myoclonic epilepsy, may be
biologically related as second cousins or closer [1].
passed on from parent to child [10] and the person's
Worldwide, 690 million people are consanguineous
risk of developing the disorder partly depends on
[2]. Up to 50 % of marriages in Arab countries are
what type of epilepsy the family member has had.
consanguineous [3]. In contrary, many developed
There are various risk factors that could lead to
countries like USA both second degree and third
epilepsy. However, a few studies have shown that
degree marriages are restricted by law. In Saudi
there is a strong link between epilepsy and
Arabia,
reports
showed
high
rates
of
consanguinity and with family history. Increased
consanguineous marriage across regions [4], which
risk of epilepsy at least by 2.2 folds has been also
was associated with mental retardation, neural tube
reported after familial marriages in a study from
defects and other hereditary neurological diseases [5,
Iran. Another study in Qatar showed that mental
6]. The health complications that are associated
retardation and epilepsy were significantly more
with consanguinity are caused by the expression of
common in offspring of consanguineous couples
recessive genes inherited from a common ancestor
[11]. In this study we had investigated the role of
[7]. Further population studies revealed an increased
parental consanguinity and the risk of epilepsy
familial clustering of epilepsy among first degree
among siblings and children and the role of
and to a lesser extent, second degree relatives [8].
previous family history in the disorder's
Epilepsy is defined as a chronic neurological
developing.
condition characterized by recurrent seizures that
Objective
are caused by abnormal cerebral nerve cell activity
This study was conducted to determine the
and has a very high incidence all across the world. prevalence of consanguinity between parents among
5291
Received: 20/12/2017 DOI: 10.12816/0044844
Accepted: 30/12/2017
c:\work\Jor\vol7011_11
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1929-1935
Histone Deacetylase Inhibitors in Cancer
Alsubhi Abdulrahman, Al Sultan Ahmed Yousef A.
Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
Corresponding author: Alsubhi Abdulrahman,mobile: +36-20-3154992 E-mail aalsubhi@hotmail.com
ABSTRACT
The epigenetic modifications can change the state of a part of the DNA by different enzymes such as the
histone deacetylases. Dysregulation of the epigenetic mechanisms is associated with the initiation and
progression of cancer. The reversibility of this dysregulation in epigenetic modifications makes it an attractive
target for cancer therapy and drug discovery scientists. We conducted a computerized Literature search
involving human subjects, published in English until December 2017, and indexed through Medical
Databases; MEDLINE/PubMed, EMBASE, and Web of Science. We reviewed articles performed for
prospective and other types of studies related to histone deacetylases inhibitors which can help cancer
patient's status during the therapy. Several investigational drugs for cancer therapy are in clinical trials.
Interestingly, US Food and Drug Administration has already approved four histone deacetylases inhibitors
drugs for hematological malignancies but not for solid tumors. Currently, different histone deacetylases
inhibitors are under study for both hematological and solid tumors as single agents or in combinations. In this
review, we will discuss some the approved histone deacetylases inhibitors, and the one in clinical trials.
Keywords: Histone, Deacetylase, Cancer, Epigenetic
INTRODUCTION
The structure of chromatin is responsible for
the accessibility of DNA to transcription factors.
tumorigenesis and are targets of the epigenetic
Therefore it is essential to determine the activity of
drugs in the clinics. Class I HDACs include
genes. The N- and C-terminal tails of histones
HDAC1,
undergo reversible post-translational modifications,
HDAC2. They are restricted to the nucleus of the
which will cause a change in the interaction
cells, and they have different substrates including
between the histones and the DNA. These
proteins like p53 and E2F. Class II HDACs can be
modifications include methylation, acetylation,
classified into class IIA and IIB. They differ in their
phosphorylation, glycosylation, and are related to
substrates and their localization in the cell[2].
the difference in the structure of chromatin. The
histone tails are accessible to a different type of
Histone Modification in Cancer
enzymes with various functions. For example,
Global loss of acetylated histones occurs during
histone
acetyltransferases
(HATs),
histone
cancer development and progression. This loss of
deacetylases (HDACs), and kinases can add or
histone acetylation by HDACs enzymes will result
remove covalent modifications and are called
in gene repression. HDAC enzymes are usually
writers and erasers. Proteins that can understand the
found overexpressed in several types of cancer,
histone code are known as readers.
which make them highly affected by epigenetic
Epigenetic changes make a set of labels, which
therapy. HAT enzymes and HDACs enzymes which
give information about the local state of the
work together in histone acetylation levels
chromatin and define as the histone code. This
maintaining are altered in cancer as well. Abnormal
covalent modification of the histone tails leads to
fused proteins are formed by the translocation of
activation and silencing of transcription state of the
chromosome of histone acetyltransferase and its
chromatin depending on the type and place of the
genes occur in leukemia, e.g. MOZ, and p300. This
changes. HATs mediate the acetylation of histones
fusion protein can lead to global alterations in
H3 and H4. This acetylation results in removing the
histone acetylation level and patterns in cancer[3].
positive charge of a lysine residue in histone,
causing chromatin accessibility and eventually
METHODOLOGY
helping the access of transcription factors to
We conducted a computerized Literature search,
genes[1].
published in English until September 2017, and
Histone deacetylases (HDACs) are enzymes,
indexed
through
Medical
Databases;
which remove the acetyl groups from histone and
MEDLINE/PubMed, EMBASE, and Web of
other proteins. HDACs enzymes can be classified
Science. We reviewed articles performed for
into four categories. The classical HDACs are those
prospective and other types of studies related to
enzymes which have been concerned in
histone deacetylases inhibitors. Searching relevant
9191
Received: 20/12/2017 DOI: 10.12816/0044845
Accepted: 30/12/2017
c:\work\Jor\vol7011_12
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1936-1942
Awareness of Otitis Media Risk Factors in Children among
Saudi Population in Al-Ahsa
Amnah E. Al-Hammar1, Nadiah M. Albrahim1, Fatimah B. AlAli1, Zainab A. AlHabeeb1,
LolowahE.. Al-Hammar1, Khalid A. AlYahya2, Saleh H. AlJarudi3.
1-College of Medicine, King Faisal University, 2- Head & Neck Surgery Department,
King Faisal University, 3- Dhahran Eye Specialist Hospital
Corresponding Author: Amnah Ebraheem AlHammar, mathematical1162@hotmail.com.
ABSTRACT
Background: Otitis media (OM) is a common childhood disease where 75% of all children have had one episode
of OM by the age of five and for some it may continue throughout school life. Several risk factors for AOM have
been identified such as anatomic abnormality, infant feeding methods, passive smoke exposure, group daycare
attendance...etc. The persistence of the disease and its long-term effects is due partly to lack of awareness of the
disease among parents.
Objective: This study was designed to assess the knowledge of risk factor of otitis media among Saudi population
who live in AlAhsa province.
Subjects and Methods: After ethical approval, data information was collected through a cross-sectional survey
which performed among Saudi population. Statistical analysis computed using (SPSS).
Result: The study comprised 924 participants, females were the majority 639 (69.2%), age groups 18 and older.
Inadequate level knowledge was 85.39%.Winter and young babies are the most frequent risk factors 50% and
73.1% respectively.
There were no statistical significant associated of demographic characteristics (age, job, number of children, and
income) and knowledge and awareness of otitis media. But there is with educational level p=0.006.
Conclusion: Knowledge and awareness of OM risk factors are inadequate, extensive health education,
encouraging and training of parents are recommended.
Keywords: otitis media, acute, children, risk factors, breast feeding, upper respiratory tract.
INTRODUCTION
which, in turn, alter the pressure within the middle
Otitis media means inflammation or infection of
ear. When fluid cannot drain, this permits pathogenic
the middle ear, this term covers a wide range of
virus and bacteria to colonize the normally sterile
middle-ear problems. Otitis media (OM) is a common
middle ear space, this lead to otitis media, and any
childhood disease seventy five percent (75%) of all
infection of the middle ear can spread to surrounding
children has had one episode of OM by the age of
structures with serious results, a relatively common
five1-3. Worldwide systematic review estimated that
complication of AOM is acute mastoiditis, defined as
there are 709 million new cases of AOM annually,
acute inflammation of the mastoid periosteum and air
with greater than half in children less than five years
cells, The incidence is 1.26.0 in 100,000 and usually
of age4.
occurs in children under 2 years of age6.
However, most children have only occasional
It can be unnoticed and in some cases may remain
episodes of AOM, or none at all, but some are
underestimated since it has a high rate of spontaneous
susceptible to recurrent or severe ear infections; those
healing. Irregular response to antimicrobial treatment
children having had three or more episodes of AOM
can be produced due to its different etiology (viral,
before their third year and named `otitis prone'5.
bacterial or both combined); this fact sometimes
Acute OM (AOM) usually affects children aged
makes it difficult to determine whether we are dealing
under two years, and presents with acute onset signs
with a new episode of infection or whether it is the
and symptoms of otalgia and fever, in a child that is
same still unresolved (most of all infants who present
systemically unwell. It is acute inflammation, and
continuous infections of the adenoids, pharynx,
may be caused by bacteria or viruses.
tonsils or upper respiratory tract)5.
Acute otitis media is usually a result of obstruction
Episodes of AOM and the number of recurrent
of the Eustachian tube. Because of obstruction, fluid
otitis media are higher in male. Teele reported that
buildup behind eardrum and inflammation occur,
66% and 86% of males versus 53% and 77% of
females had had an episode of otitis within their first
6391
Received: 20/12/2017 DOI: 10.12816/0044846
Accepted: 30/12/2017
c:\work\Jor\vol7011_13
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1943-1946
Phototherapy Induced Hypocalcemia, a Jordanian and Saudi Experience
Mohammed Abdulrahman Al-ali, Abdullah Ismail Sawma, Naif Mutkhan Alshrari,
Mostafa Moheb Rizk, Ghassan Saleh Salama, Hind Jaza Alotaibi
Al-Qurayat General Hospital
Corresponding author: Mohammed Abdulrahman Al-ali, email: malali10@moh.gov.sa
ABSTRACT
Background: neonatal hyperbilirubinemia is a common condition in the first few days of life (1) and it can be
divided into: pathological and physiological and indirect (unconjugated) and direct (conjugated)
hyperbilirubinemia. Objective: This paper aimed to evaluate the effect of different types of phototherapy on
serum calcium of both preterm and full-term infants with indirect hyperbilirubinemia, in either supine or prone
position. Methods: data were taken from 100 newborns candidate by divided them into two groups. Blue and
white light phototherapy were equally used for different infants of both groups. Results: the results showed
that 31% developed hypocalcemia, 20% preterm and 11% full term infants. 38% developed hypocalcemia,
where among infants who received prophylactic phototherapy 24% developed hypocalcemia. 60% of infants
who received extensive phototherapy developed hypocalcemia, where 27.7% of infants who managed with
single phototherapy developed hypocalcemia. Seventeen of the infants who managed in prone position and 14
infants of those who received phototherapy in supine position developed hypocalcemia. Conclusion: all in all,
19 infants developed hypocalcemia under blue light and 12 received white light phototherapy. Phototherapy
induced hypocalcemia in both full term and premature infants. In addition to the common practice of
monitoring the total serum bilirubin and PCV in all newborns on phototherapy, it is important to monitor the
total serum calcium on daily base.
Keywords: phototherapy, calcium, bilirubin, preterm, full-term infant.
INTRODUCTION
hyperbilirubinemia need therapeutic phototherapy
Neonatal hyperbilirubinemia is a common
(25 preterm infants and 25 full term infants) and B-
condition in the first few days of life (1) and it can be
(control group) infants with total serum bilirubin
divided into: pathological and physiological and
need no therapeutic, but prophylactic phototherapy
indirect (unconjugated) and direct (conjugated)
(25 preterm infants and 25 full term infants). Blue
hyperbilirubinemia. Phototherapy proved to be a safe
and white light phototherapy were equally used for
and effective way of treatment in cases of indirect
different infants of both groups. In each group, half
hyperbilirubinemia even it can lead to some
of the infants were managed mostly in prone
complications such as eye trauma, skin rash,
position, while the other half was managed in supine
dehydration due to rise in temperature and increase
position. Total serum bilirubin, serum calcium, total
evaporation, loose stool, chills, damage to DNA and
protein and serum albumin were taken on daily base.
bronze baby syndrome (1-4) . A transient decrease in
Corrected and ionized serum calcium were
total serum calcium in newborns with indirect
calculated before the initiation of phototherapy, for
hyperbilirubinemia, while under phototherapy was
the subsequent 3- 5 days of phototherapy and 2 days
reported by many authors (1,2,5-13).
after termination of phototherapy.
Objective: This study aimed to evaluate the effect
The following inclusion criteria were accepted:
of different types of phototherapy on serum calcium
infants with normal total serum calcium, of more
of both preterm and full-term infants with indirect
than 28 weeks gestational age, more than 850 grams
hyperbilirubinemia, in either supine or prone
birth weight, less than 14 days of life and who
position.
started to have indirect hyperbilirubinemia after the
second day of life or more.
MATERIAL AND METHODS
The infants excluded from the study if met any
This was a cross sectional study that was
of the following criteria: infants with direct
conducted between March 2016 and November 2017
hyperbilirubinemia,
infants
received
calcium
at the level III neonatal intensive care unit and
gluconate either intravenously or orally before the
pediatric ward at Prince Hashem Military Hospital
initiation of phototherapy. Moreover, those who
and Al-Qurayyat General Hospital, Al-Jouf. A total
needed exchange transfusion or blood transfusion for
of 100 newborns candidate for phototherapy (50
any reason, those who given sodium bicarbonate to
preterm and 50 full terms) were divided into two
correct metabolic acidosis, infants on total parenteral
main groups using the odd (group A) and equal
nutrition, those with congenital heart defects, infants
numbers (group B) according to the sequence of
of diabetic mothers, infants with refractory
admission:
A-
infants
with
indirect
hypocalcemia and dysmorphic infants.
1943
Received: 20/12/2017 DOI: 10.12816/0044847
Accepted: 30/12/2017
c:\work\Jor\vol7011_14
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1947-1951
Accuracy of Breast Cancer Screening Using Film
Mammography in Comparison to Digital Mammography
Lama Abed Abdullah Alorabi 1 , Eman M. Algorashi 2
1-College of Medicine, Umm Al-Qura University, 2- College of Medical Radiological Sciences, Sudan
University of Science and Technology
Corresponding author: Lama Abed Abdullah Alorabi , Email: dr.research222@gmail.com
ABSTRACT
Aim of the work: digital mammography may achieve better images than does film mammography in young
women, especially those who are less than 50 years old, where breast is characterized by dense breast tissue. This
review aimed to compare the accuracy of screening using film mammography versus digital mammography in
detection of breast cancer. Methods: an electronic search was conducted in MEDLINE and EMBASE by using
PubMed search engine. The search resulted in 48 relevant studies, then after exclusion of duplicated and studies
with different outcomes only 4 studies found eligible to be included in this review. The data were extracted using
data extraction tables.
Results: the search resulted in four potentially relevant studies that reported clinical trials on a comparison
between breast cancer screenings using film mammography versus digital mammography. Conclusions: the
digital mammography offers advantages over film mammography namely, easier access to images and computer
assisted diagnosis, improved means of transmission, retrieval and storage of images; and the use of a lower
average dose of radiation without a compromise in diagnostic accuracy
Keywords: mammography, digital, film, accuracy, breast, cancer.
INTRODUCTION
Mammography is the most effective modality to
A study showed that digital mammography may
early detection of breast cancer (1). The use of
achieve better images than does film mammography
screening mammography is associated with the
in young women, especially those who are less than
detection of breast cancer at an earlier stage and
50 years old, where breast is characterized by dense
smaller size (2). There is a current consensus that
breast tissue (9). High density of breast tissues
screening mammography decreases the mortality
decreases the ability of mammography to detect
rate related to breast cancer in females 40 years old
breast lumps (10) and elevates the risk of breast
or older (3).
cancer (11). This review aimed to compare the
However, the positive predictive value of
accuracy of screening using film mammography
mammographic diagnosis is only about 15%30%
versus digital mammography in detection of breast
(3). As the number of patients undergoing
cancer.
mammography increases, it will be increasingly
important to improve the positive predictive value of
METHODS
this procedure in order to decrease patient
An electronic search was conducted in
discomfort and costs (4). A study showed that
MEDLINE and EMBASE using PubMed search
mammography is sensitive in diagnosis and
engine with this search strategy (Breast cancer OR
screening of breast cancer, but with a high false-
beast tumor OR breast malignancy), film
positive rate (5). So far, conventional screen-film
mammography OR conventional OR film-screen),
mammography with high spatial resolution has been
digital mammography and accuracy OR specificity
the modality of choice for screening programs (6).
OR sensitivity. The search resulted in 48 relevant
Digital mammography has been developed to
studies, then after exclusion of duplicated and
overcome the drawbacks of film mammography in
studies with different outcomes only 4 studies found
terms of separation the stage of image taking and
eligible to be included in this review. The data were
display which optimize the outcomes of both
extracted using data extraction tables for the items
stages(7). Digitally processed image allows the
demonstrated in table 1.
control of contrast, thus, this contrast can be elevated
The study was done after approval of ethical
in the dense parts of the breast with the lowest
board of Umm Al-Qura university.
contrast (8).
1947
Received: 20/12/2017 DOI: 10.12816/0044848
Accepted: 30/12/2017
c:\work\Jor\vol7011_15
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1952-1958
Surgical Management of Patients with Infective
Endocarditis: A Systematic Review
Nouf Saleh Sadun (1), Thamer Hassan Mobarki (2)
(1) College of Medicine, Umm Al-Qura University, (2) Faculty of Medicine, Jazan University
Corresponding author: Nouf Saleh Sadun, Email: naouf.sadun@gmail.com
ABSTRACT
Introduction: Replacement of the heart valves has been spread recently with wide variety of types and surgical
techniques. There is, however, no consensus regarding the best type and/or techniques of the surgical treatment
of infective endocarditis.
Objective: The aim of the systematic review was to evaluate the evidence-based published articles dealt with
different types of valve replacement in the management of infective endocarditis.
Methods: An electronic search was conducted on the electronic search engine PubMed including Medline.
Keywords used for this research included; infective endocarditis, bacterial endocarditis, surgery, valve
replacement, outcomes, timing, mortality, relapse and death.
Results: Among the screened articles there were a total of 11 articles included for this systematic review. Out
of which, there were 6 prospective randomized clinical trials and the remaining 5 studies were prospective
clinical trials without randomization.
Conclusion: From the findings of this review it can be concluded that the infective endocarditis is still a life-
threatening disease requires more efforts for prevention and management. Surgical treatment of infective
endocarditis with prosthetic or biologic valves does not differ significantly in outcomes or complications with a
little bit higher in complications when using biologic valves.
Keyword: infective endocarditis, bacterial endocarditis, surgery, treatment, valve replacement.
INTRODUCTION
endocarditis varies according to the cause and type
Endocarditis, also called infective endocarditis (IE),
of infection which may be medicinal or surgical (6, 7).
is an infectious disease affects the heart
Surgical treatment of IE differs widely among
endocardium. Its effects can be either local or
individuals reflecting that the indication for surgical
systemic resulting in insufficiency of the valve(s) or
intervention is depending on many factors and is not
a variety of systemic signs and symptoms.
absolute issue (8). A number of international
Unfortunately, there is increase in the number of
guidelines have been published recently based on the
individuals with infective endocarditis in the recent
evidence-based recommendations regarding valvular
years which in turn increase the need for surgical
heart surgery. The European Society of Cardiology
interventions and/or innovations in cardiac devices
(ESC), however, has published its own guidelines on
and prosthetic valves. There is a higher of risk in
the management of infective endocarditis. It follows
men than women particularly elders, intravenous
the same guidelines and recommendations of the
drug users, and sometimes associates with systemic
American Heart Association (AHA) regarding the
diseases such as: diabetes mellitus, cancer, or
indications of surgical treatment for infective
alcoholism. Some factors have been identified as
endocarditis (9).
risk factors including: heart valve disease,
Surgical treatment of infective endocarditis is
replacement of valve, congenital heart disease, and
considered the most difficult surgeries facing the
previous infective endocarditis (1-5). IE can either
cardiac specialists. It requires more skills in
bacterial or non-bacterial disease. For the former,
removing the infected tissue of the endocardium and
staphylococcus aureus is the most suspected type
restoring the function of the heart. Moreover,
causing IE. The most affected valves with infective
patients in need for surgical treatment of IE usually
endocarditis are as follows (in descending order):
present with some other systemic diseases or
mitral valve, aortic valve, both mitral and aortic
dysfunction of the cardiac muscles (10, 11).
valves, tricuspid valve, and with rare frequency the
Replacement of the heart valves has been spread
pulmonary
valve.
Treatment
of
infective
recently with wide variety of types and surgical
techniques. There is, however, no consensus
1952
Received: 20/12/2017 DOI: 10.12816/0044849
Accepted: 30/12/2017
The frequency of Palmaris Longus absence among female students in King Faisal University in Al- Ahsa, Saudi Arabia.
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1959-1962
The Frequency of Palmaris Longus Absence among Female Students in
King Faisal University in Al-Ahsa, Saudi Arabia
Alabbad, Aqilah A, Alkhamis, Marwah H, Alsultan, Marwah S, Alahmad, Sarah A
College of Medicine, King Faisal University
Corresponding author: Aqilah Ali Alabbad, E-mail: aana-213@hotmail.com
ABSTRACT
Background: Palmaris longus (PL) is one of the forearm muscles that lie between the flexor carpi ulnaris and the
flexor carpi radialis muscles. PL action is flexion of the hand at the wrist and making the palmar aponerurosis tense.
Plastic surgeons utilize the Palmaris longus in restoration of lip and chin defects.
Objectives: We sought to determine the frequency of the absence of the palmaris longus in Saudi Arabia among
female students in King Faisal University, AL-Ahsa. Materials and Methods: Two hundred normal subjects were
chosen randomly from King Faisal University female students. Subjects who had gone through a surgical procedure
or have any deformities in the forearm were excluded. We have examined the presence or absence of palmaris longus
using three tests. Subjects were asked to do standard test for the assessment of PL tendon. If PL cannot be detected
by the standard test, two more tests were performed to confirm the absence. Results: The overall prevalence of
absence both unilaterally and bilaterally is 40.5 %. Unilateral absence was 20.5%. The bilateral absence was 20%.
The distribution on the right and left was 29% and 31.5% respectively.
Conclusions: The present study found palmaris longus to be absent equally bilateral and unilateral in more than one
third of the sample and significantly more common in the left side.
Keywords: Palmaris longus, agenesis, forearm, Saudi Arabia.
INTRODUCTION
The palmaris longus (PL) is a slender, spindle
shaped weak flexor of the wrist and it is located
0.6% (in the Korean population) to 63.9% (in the
medial to the flexor carpi radialis (FCR). The number
Turkish population) [6, 7].
and form of PL muscle is extremely variable [1]. The
A lot of studies have been made regarding the
PL muscle may be absent, double, split, tendinous,
frequency of palmaris longus absence in Korea [8], Iran
digastric and may have various insertions. It may be
[9], Egypt [10], and East Africa [11] and others. However,
inserted on the flexor retinaculum, the fascia of the
the frequency of palmaris longus absence have not
forearm, the fascia and the muscles of the hypothenar,
been studied yet in Alahsa.
the short abductor of the thumb, near the
Taking into account the large variability of
metacarpophalangeal joints, the tendon of the flexor
palmaris longus presence, the aim of this study is to
carpi ulnaris muscle, the pisiform bone or the scaphoid
investigate the frequency of Palmaris longus absence
bone [2].
among female students in king Faisal University and
The presence of the PL can be determined
to compare the results to the other studies worldwide.
through
noninvasive
and
standard
physical
The results of our study are going to be useful for the
examination of the volar wrist [3].
surgeons working in our population.
Considering its dispensability, surgeons agree
that PL is the best choice for tendon grafts in tendon
MATERIALS AND METHODS
reconstruction, helping the function of paralyzed
A cross sectional study was designed to investigate
muscles used for repairing ptosis, treatment of facial
the absence of Palmaris longus in both sides in a
paralysis, and urinary incontinence. Plastic surgeons
sample of normal population which was taken from
also utilize the PL in lip augmentation and restoration
female students of king Faisal University included 200
of lip and chin defects. As its absence is immaterial to
students randomly. Their ages range between 18 to 25
the function of the wrist, PL has the greatest variation
years old. We excluded the subjects who have done
in the human body and its most common variation is
any surgical procedure in the forearms or have any
agenesis (PLA) [4]. However, this muscle variation can
deformities in the forearms.
lead to median and/or ulnar nerve compression
The study was done after approval of ethical board
syndromes in some rare cases [5].
of King Faisal university.
The rate of congenital absence of the PL is
estimated to be 15% among individuals worldwide and
We have examined the presence of Palmaris
its incidence is population-dependent ranging from
Longus muscle using three tests. The subject was
1959
Received: 20/12/2017 DOI: 10.12816/0044850
Accepted: 30/12/2017
c:\work\Jor\vol7011_17
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1963-1969
Recent Dynamic Ovarian Reserve Modalities
Mohammed A. Mohamed, Hossam H. El-Ktatny, Mai I. Abd El-hamed
Department of Obstetrics and Gynecology,
Faculty of Medicine, Al-Azhar University (Assuit)
Corresponding author: Mai I Abd El-Hamed; Mobile: 01004159460; Email: mai_i37@yahoo.com
ABSTRACT
Background: the pool of primordial follicles in the ovary or ovarian reserve is a major factor in the human
fertility potential. The ageing ovary is characterized by reduction of the number of primordial follicles and
this loss accelerates in the late 30's and precedes the menopause by 10-12 years. Woman's age alone or with
combination of biochemical markers, dynamic tests and ultrasound measurement fail to predict this loss
accurately. Aim of the Work: this study aimed to assess the recent dynamic ovarian reserve tests including
antral follicle count, ovarian volume and ovarian blood flow (OBF) as a predictive value and less cheap
method for evaluation of ovarian reserve. Patients and Methods: this randomized controlled trial was
conducted on 200 women having unexplained infertility in outpatient clinic at Sohag General Hospital and
private clinics during the period from 2016 to 2017 after taking a verbal consent from each case after
explanation of the purpose of the study was taken. Results: mean baseline ovarian volume in cycle day 3 of
infertility group was 15.28±12.1, while it was 12.6±4.8 in the control group. It also showed that the mean
baseline total antral follicle count in cycle day 3 of infertility group was 5.98±1.74. While, it was 10.1±2.5 in
the control group. The mean baseline resistance index of ovarian arteries of infertility group was 0.56±0.12.
While, it was 0.47±0.058 in the control group. It also showed that the mean baseline pulsatility index of
ovarian artery of infertility group was 0.75±0.15, while it was 0.9±0.26 in the control group. The differences
between the two groups were significant regarding baseline total AFC, baseline OV and the rest of variables.
It was even found that AFC compared to other predictors was considered the strongest predictor.
Conclusion: antral follicular count and the mean ovarian volume measured through the transvaginal
ultrasonography is a non-invasive method and easy to perform and can be considered as an accurate method
for assessment of the ovarian reserve. Ovarian stromal blood flow may also become one of the parameters.
Recommendations: perform transvaginal ultrasound at third day of the cycle in women undergoing
infertility treatment is a good predictor for ovarian reserve. Early evaluation of ovarian reserve is very
important step in the infertility work up especially in infertile women above the age of 35 years, women with
unexplained infertility and women with poor response to ovulation induction.
Keywords: dynamic reserve modalities, antral follicle count, ovarian volume, ovarian blood flow.
INTRODUCTION
and/or quality of primordial follicles remaining in
Considering modern trends of maternity
the gonads after each wave of follicular growth. In
postponement and the increasing demand for
other words, those tests do not ideally reflect the
assisted reproduction technologies (ART), the
pool of unrecruited follicles, which may be
evaluation of functional ovarian reserve has arisen
responsible for the continuity of ovulatory cycles
to better advise interested couples, helping
and therefore, for the long-term reproductive
physicians in the inference of follicular response
potential. The most commonly used tests for the
and success rates and guiding the elaboration of
evaluation of ovarian reserve in infertile women
individualized stimulation protocols, with a
were divided into static (endocrine and
reduction of emotional and financial burdens of
ultrasonographic tests performed in the early
hard and stressful therapeutic processes. In this
follicular phase) and dynamic (endocrine tests
context, the identification of women with a lower
assessing ovarian response to exogenous
reproductive potential is a great challenge for
gonadotropic stimulus) (1).
reproductive medicine specialists (1).
Ovarian reserve assesses the quality and quantity
Sharara and Scott (2) emphasized that an
of remaining oocytes in an attempt of predicts the
ideal ovarian reserve parameter should be easily
reproductive potential (3).Ovarian reserve is done
measurable, minimally invasive, inexpensive and
to identify those individuals who are at risk of
should have good predictive values (1).
decreased or diminished ovarian reserve as
Serum and ultrasonographic markers have been
women older than 35 years old who have not
tested to infer the gonadal reserve of infertile
conceived after 6 months of attempting
women, but none of them has been proven to
pregnancy, women with history of cancer were
confidentially reflect the complex follicular
treated by gonadotoxic therapy, pelvic irradiation
dynamics or to be strongly correlated with the size
or ovarian surgery for endometriomas (4).
1963
Received: 20/12/2017 DOI: 10.12816/0044851
Accepted: 30/12/2017
INTRODUCTION
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (10), Page 1970-1978
Role of Radiofrequency in the Management of Chronic
Low Back Pain
Mohamed W. Samir, Hatem A. Sabry, Mohamed M. Kotb, Mohamed H. El Boghdady*
Department of Neurosurgery, Faculty of Medicine, Ain Shams University
*Corresponding author: Mohamed H El Boghdady; Mobile: 01114022415; Email: dr_mhb.elboghdady@hotmail.com
ABSTRACT
Background: low back pain (LBP) is related to disability and work absence and accounts for high
economical costs. The management of LBP comprises a range of different intervention strategies including
surgery, drug therapy, and non-medical interventions. Failed back surgery syndrome is a common problem
with enormous costs to patients, insurers, and society, defined as persistent back and/ or leg pain after spine
surgery. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal
selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology. Aim of the
Work: to evaluate the efficacy, safety and outcome of radiofrequency as a method for management of
patients with chronic low back pain. Subjects and Methods: this prospective study was conducted at El
Galaa Military Hospital starting from January 2017. Twenty-five patients with chronic low back pain with
mal-response to medical treatment justified for receiving interventional pain management as a conservative
method of treatment of low back pain. They were subjected to radiofrequency neurotomy as a method for
managing low back pain. Results: there was highly statistically significant decrease in pain score
immediately, 1 week, 1 month and 3 months than pain score before RF with p-value < 0.01and there was
highly statistically significant difference between daily living activities before RF and daily living activities
at different times of measurement with p-value < 0.01. Conclusion: low back pain is a medical, social and
economical problem. Radiofrequency neurotomy had advantage regarding the long term follow up but the
costs and equipment-wised problem still make it less prevailed. Recommendations: longer follow up and
randomized study if could be conducted the results may indicate much clues.
Keywords: radiofrequency, management low back pain.
INTRODUCTION
pharmaceuticals, manual therapy (eg, massage,
Low back pain is extremely prevalent,
physiotherapy, spinal manipulation), exercise
and is the second most common reason for people
to seek medical attention (1). Low back pain
therapy
(eg,
aerobic
activity,
muscle
accounts for 15% of all sick leaves from work,
strengthening), and educational or psychological
and is the most common cause of disability for
therapies (eg, cognitive behavioral therapy,
persons less than 45 years age (2).
support groups, educational sessions). If
A major proportion of the adult
conservative treatments are unsuccessful, more
population has low back pain at some stage of
invasive methods, such as steroid injections, nerve
life. Although most patients are treated
blocks, cryoablation, radiofrequency ablation
successfully with conservative treatment or
(RFA) or surgery, can be attempted(5).
without treatment, a substantial group of patients
Radiofrequency denervation of medial
develop chronic pain symptoms (lasting longer
branches is one of the treatment options for
than three months). Patients with chronic low
patients with chronic low back pain. In
back pain account for most reported healthcare
radiofrequency denervation, a radiofrequency
and socioeconomic costs (3).
generator produces an alternating current through
Schmörl and Junghanns (4) introduced
an electrode, thereby inducing ionic movements in
the concept of mobile lumbar segment in 1968 to
the tissue directly surrounding the active tip. This
refer to the junction between two lumbar
leads to molecular friction and heating of the
vertebrae formed by the intervertebral disc,
tissue within a limited distance of the electrode (6).
intervertebral ligaments, articular facets and
Since Shealy(7) published his article on
muscles of the lumbar spine. Therefore, low back
radiofrequency denervation of the lumbar facet
pain may arise from several structures such as the
joint in 1976, radiofrequency denervation
discs, ligaments, musculature, sacroiliac joints
procedures have been modified by many authors
and articular facets as there may be discogenic
including Dasselaar et al. (8), Sluijter et al. (9),
pain, facet arthropathy, sacroiliac pain.
Dreyfuss et al. (10) and Cohen (11).
Conservative treatment options for
Many observational studies of patients
chronic
low
back
pain
may
include
whose low back pain was treated with facet joint
radiofrequency
denervation
have
reported
1970
Received: 20/12/2017 DOI: 10.12816/0044852
Accepted: 30/12/2017
c:\work\Jor\vol7011_19
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1979-1982
Associated Factors of Post Renal Transplant Failure
Yara Saleh Bayunus, Linah Khalid Qasim, Lama Saleh Bayunuos
Umm Al-Qura University
ABSTRACT
Renal transplantation is the best management for patients suffering from end-stage renal disease (ESRD). It
has many benefits which overcome the complications of dialysis, it has some acute and long term complications
that could result in failure. Failure of transplant is the fourth cause of death among patients with end stage
kidney disease. The causes of failure is still a debate but rejection, drug toxicity and fibrosis as well as chronic
allograft nephropathy and patient's immunity related factors. This review will provide important information
regarding the causes associated with post-renal transplant failure.
Keywords: Post transplant failure, Causes, risk factors, complications.
INTRODUCTION
Renal transplantation is the best management
The management of rejection is based on using
for patients suffering from end-stage renal disease
anti-rejection treatments that could conquer the
(ESRD) during different stages of life and has been
immune system of the recipients which would in
increased significantly even with older patients. In
turn give chance to kidney to function. Despite
western countries, even patients older than 60 years
using medications and proper precautions, rejection
old have been waiting for kidney transplant
could still happen (13, 14).
especially among Asians and Americans which had
1. Hyperacute rejection
doubled during the last 10 years (1, 2).
It is the type of rejection that occurs when the
The mortality rates was decreased among
transplanted kidney is rejected within minutes to
elderly ESRD patients who had undergone renal
hours due to the destruction of vasculature.It is a
transplantation and the quality of life was improved
type of humeral mediated immunity of the recipient
in comparison with patients on regular dialysis (3-5).
that happens when the recipient has prior antibodies
Although, the transplantation has many benefits
in contradiction of the graft and this could be due to
which overcome the complications of dialysis, it
previous transplantation or blood transfusion and
has some acute and long term complications that
multiple pregnancies (15). Activation of the antigen-
could result in failure (6). The late kidney transplant
antibody complex could result in activation of the
failure is an important problem that could increase
complement system thus induce formation of
the mortality rates and the admission to dialysis
massive thrombosis inside the capillaries thus
again (7).
inhibit the graft vascularization(16, 17).
Failure of transplant is the fourth cause of death
among patients with end stage kidney disease. The 2. Acute rejection
causes of failure is still a debate but rejection, drug
It is the type of rejection that occurs
toxicity and fibrosis as well as chronic allograft
usuallyduring
the
first
6
months
post-
nephropathy and patient's immunity related factors
transplantation. The acute cellular rejection could
(8-10).This review will provide important information
be mediated by activating lymphocytes which is
regarding the causes associated with post-renal
enhanced against the lymphoid tissue of the donor's
transplant failure.
antigen. The leukocytes of the donor's dendritic
cells could move into the circulation and work as an
Causes of post-renal transplant failure
antigen-presenting cells (APCs).
- Rejection:
Various factors are associated with transplant
3. Humoral rejection
failure and the most common cause is associated
This type is occurs either as hyperacute or
with the immune system of the recipient's body
during the first week. It is mediated by the
thus causing rejection. Rejection is based on
complement and antibody system occurs when the
recognizing the donor's kidney antigens which
allograft is injured and result in consequent
attacks it as foreign body (11, 12).
dysfunction.The antibodies could be developed
1979
Received: 20/12/2017 DOI: 10.12816/0044853
Accepted: 30/12/2017
c:\work\Jor\vol7011_20
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1983-1989
Evaluation of Awareness and Attitudes towards Common Eye Diseases
among the General Population of Northwestern Saudi Arabia
Wareef A. Al-Lahim, Reema S. Al-Ghofaili, Hyder Mirghani , Hani ALBalawi
Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
Corresponding author : Wareef A. Al-Lahim, E-mail : allahim.w@gmail.com
ABSTRACT
Background: Assessing of the population's awareness concerning eye diseases would provide a fundamental
basis and acts as a future reference to execute health promotion initiatives. Objective: This study aimed to
evaluate the public awareness and attitudes towards common eye diseases in Tabuk, Saudi Arabia.
Materials and Methods: This cross-sectional study was conducted in Tabuk, Saudi Arabia during the period
from June 2017 to December 2017. A convenient sample of 397 participants of adults aged above 18 years old
was chosen by a stratified method. A self-administered online survey included multiple choice and true-false
questions was used to obtain information about respondent's awareness regarding common eye diseases
including cataract, refractive errors, glaucoma and diabetic retinopathy.
Results: 77.6% of participants were females, 41.4% were between 18 and 25 years, 52% of the respondents
had sufficient knowledge regarding common eye problems. The most frequent sources of information were the
internet (46.7%), relatives (38.5%) and mass media (35.4%). The participant's knowledge ranged from 66.3%
for the cataract to 36.3% for refractive errors. Only educational level and job were significantly associated with
knowledge about refractive errors. The majority of the respondents (75%) reported visiting ophthalmologists
only when they have complaints and just 10% of them visited ophthalmologists regularly. When they had eye
problems, almost two-thirds visited the ophthalmologist directly whereas 9% and 7.4% of them did nothing or
depended on home therapy, respectively. Conclusion: Awareness and knowledge of adult population in
Tabuk, Saudi Arabia is suboptimal. Health education campaigns are needed to improve their knowledge and
protect them from adverse complications of these diseases.
Keywords: knowledge, cataract, glaucoma, refractory errors, diabetic retinopathy.
INTRODUCTION
health promotion strategies (1). Moreover, it is
Visual impairment represents one of the pivotal
believed that it will not only help in raising
health issues of the public with an estimated 253
awareness, but also encourages the community to
million people are suffering worldwide, of which 36
take liability towards its eye health as well as
million are blind. The two most leading causes are
employing available eye care services appropriately
uncorrected refractive errors and then un-operated
(2).In the light of what was previously mentioned,
cataract (1). People who are older than 50 years
assessing the extent of the population's awareness
constitute more than 80% of visually impaired
concerning eye diseases would provide a
individuals. Furthermore, the prevalence of diseases
fundamental basis and act as a future reference to
with a potential effect on the eye such as diabetes
execute such health promotion initiatives.Seldom
mellitus sustain a tremendous increase which puts
studies have been published describing knowledge,
more people at a higher risk of having conditions like
attitude and practices associated with eye diseases
age-related
macular
degeneration,
diabetic
among the general population of Saudi Arabia (5,6).
retinopathy and glaucoma (1,2). Fortunately, vision
Up to our knowledge, no such study addressed this
impairment can be prevented or cured in almost 80%
issue among people of Tabuk city.Thus, the purpose
of conditions (1). However, insufficient awareness
of our study was to evaluate the public awareness
about sight-threatening eye diseases may contribute
and attitudes towards common eye diseases such as
to the delay of seeking medical advice and losing the
glaucoma cataract, diabetic retinopathy and
opportunity of timely interference and prevention (3).
refractive errors in Tabuk, Saudi Arabia.
Indeed, increased awareness of these conditions will
likely
promote
effective
management
and
MATERIAL AND METHODS
consequently result in minimizing the burden of
This study was conducted at the Faculty of
visual impairment and expense of eye care (4).
Medicine, University of Tabuk, Tabuk city, Saudi
Level of awareness regarding ocular diseases
Arabia. Tabuk city, situated in north-western Saudi
could be affected by various factors such as age,
Arabia, Tabuk is the provincial capital and
gender, education level and socioeconomic status (3).
headquarters of the Governor of the Tabuk region
As reported by Waleed et al. older people and
and it is the largest city in North Western Saudi
females
were
more
knowledgeable
(5).
Arabia. It has a population of 534,893 (2010 census).
Implementation of campaigns and community-based
It is close to the JordanSaudi Arabia border and
education programs is an influential element of eye
houses the largest air force base in Saudi Arabia. The
1983
Received: 20/12/2017 DOI: 10.12816/0044854
Accepted: 30/12/2017
c:\work\Jor\vol7011_21
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1990-1991
PUVA-Induced Skin Cancer in Dark-Skin Patient: A Case Report
Ahmed Aljaber1, Yousef Binamer2
1Medical intern, King Saud bin Abdulaziz university for health sciences,
Riyadh, Saudi Arabia
2Department of Dermatology, King Faisal Specialist Hospital &Research Centre, Riyadh 11211,
Saudi Arabia
Corresponding author: Yousef Binamer, dr.binamer@gmail.com, Department of Dermatology,
King Faisal Specialist Hospital &Research Centre, Riyadh 11211, Saudi Arabia
ABSTRACT
Non-melanoma skin cancer is reported to be a cancer with highest prevalence in the world. Different risk
factors have been identified, e.g., Genetic factors, skin-type, ethnicity, and iatrogenic. The main iatrogenic
factors are radiation and drugs, mainly immunosuppressive medications, and oral psoralen and ultraviolet-A
(PUVA). It is known in the literature that exposure to more than 250 sessions of PUVA could be a risk for
developing skin cancer. However, it was reported in fair skin patients.
Herein, we report for the first time, a PUVA-induced basal cell cancer in a type-4 skin patient after receiving
400 sessions.
Keywords: PUVA; basal cell carcinoma; skin cancer.
INTRODUCTION
PUVA (psoralen and ultraviolet-A) is an old
effective therapeutic modality. It has been used in
many skin diseases, most commonly eczema,
vitiligo, and psoriasis [1]. However, it falls out of
favor due to side effects. Most of the phototherapy
units have shifted into narrow-band ultraviolet
light therapy (NB-UVB). One of the reported
concerns is the non-melanoma skin cancer
(NMSC) after using PUVA therapy [2].
Murase et al [1] reported in one study that there is
no higher risk after using PUVA among Arabian
African and Asian people.
In this report, a case of basal skin cancer in a
Figure 1. Multiple nodules on arms (CTCL) with
dark-skin patient after a treatment of 400 sessions
lentigines on trunk.
of phototherapy for T-cell lymphoma has been
studied.
Case Report
A 76-year-old male, a known patient of T-cell
lymphoma 30 years ago, during which he received
400 sessions of oral PUVA and more than 600
sessions of NB-UVB. On physical examination, he
has three basal cell carcinomas (BCCs) on trunk
with generalized lentigines. The diagnosis was
made based on biopsy confirmation. He underwent
curettage and dissection and received isotretinoin
20 mg daily for one year. Since then, he developed
two more BCCs which was treated with topical 5-
fluorouracil cream (Figs. 1,2).
Figure 2. Multiple lentigines on trunk with basal
cell carcinoma.
1990
Received: 20/12/2017 DOI: 10.12816/0044855
Accepted: 30/12/2017
c:\work\Jor\vol7011_22
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 1992-1999
The Prevalence of Neck Pain and The Relationship Between Prolonged
Use of Electronic Devices and Neck Pain IN: A Saudi Arabia,
Cross- Sectional Study in Saudi Arabia
Abdulrahman Nasser Alzaid, Omar Abdulmohsen Alshadokhi,Abdulrahman Yousef Alnasyan,
Meshal Yahya AlTowairqi,Tariq Majed Alotaibi,Faisal Hammad Aldossary
Imam Mohammed bin Saud Islamic University
ABSTRACT
Background: Since the use of smartphones has increased recently, their impact on people individual's health is
not well established.It is important and critical to examine and discover the presence, absence or the magnitude
of this impact, especially among young people, because the pediatrics in certain communities constitutes >25%.
Aim of the work: determination of the prevalence of neck pain among children/adolescents and its relationship
with time spent using electronic devices (e-devices).
Material and methods: This cross-sectional study was conducted in Saudi Arabia using an online google survey
form, which was distributed through social media to 2435 participants to find out the prevalence of neck pain
among pediatric population and its relationship with e-devices use .
Results:Our study showed that roughly a quarter of the participants in Saudi Arabia have pediatric population
having neck pain, and mostpediatric sufferers are between 15-18 years. More time spent using e-devices was
associated with increased complaints of neck pain, specifically, children at the age of 7-11 years spending 5-8
hours/day on e-devices. Around 70% had an aching pain that required them to ask for Doctor's.
Conclusion: The research sample reported that children's use of electronic devices showed a close association
with neck pain and the more the child spends time using an electronic device the greater is the complaint of neck
pain. We found that there is a positive correlation between long time smart devices use and neck pain.
Keywords: neck pain, children, e-devices, duration of time.
INTRODUCTION
Finland showed that neck pain occurs at least once
In the last few years, smart phones and
a week in
electronic
devices
(e-devices;
smartphones,
computers, and others) have been become widely
approximately 26% of the population aged 14-18 -
spread among many communities and across all
years-old (5). Another cross-sectional study was
ages.However, their effect on human physical and
held in England with 679 schoolchildren aged 12-
mental health still a dilemma is not known. An
14 years showed that 27% of the children reported
American study (2017) had concluded that 77% of
neck pain at least one day per month (6). Another
the American population in 2017 are using smart
cross-sectional study of in Shanghai with 3600 high
phones, a dramatic increase from 33% that was
school students aged 15-18 years held on Shanghai
reported in 2011(1). According to the Saudi general
showed significant increases in neck and back pain
authority for statistic in 2017 the Saudi age group
for four days or more a month among those who
(0-19) years in Saudi Arabia constituting 39.1% of
were using digital products-devices (7). Lastly,
the Saudi population, and for all population (Saudi
another cross-sectional study was conducted in
and non-Saudi) of the same age group they
Riyadh, Saudi Arabia at King Saud University with
constitute 31.6% (2).
78 participants (with mean age 0f 21.3 years), the
Poor neck posture (forward head posture) is
result showed a clear association between
noticed while using smartphones, which may lead
prolonged usage of smart phones and neck pain (8).
to neck pain. Neck pain has a broad range of
Therefore, we thought to hold a cross-sectional
differential diagnosis is ranging from benign to
study in Saudi Arabia using google survey
live- threatening causes (e.g., trauma, infection,
introduced through the social media and 2435
malignancy) and, many researches have established
participants responded. The target population was
a correlation between neck pain and the use of
pediatrics from 0-18 year.The aim of this study is to
smart devices(3, 4). A cross- sectional study in
determine the prevalence of neck pain and to assess
the relationship between prolonged use of smart
1992
Received: 20/12/2017 DOI: 10.12816/0044856
Accepted: 30/12/2017
c:\work\Jor\vol7011_23
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2000-2003
Pediatric Pharyngitis: Etiology and Management Approaches
Taghreed Abdualaziz Almarshad1, Alanoud Saleh Alsaiari2, Waseem Morshed Qaq3,
Maria Mohammed Alshehab4, Waleed Abdulaziz Almosfer5, Mohammad Ridha Al Eid6,
Salha Ali Asery7, Marwa Khalifa Bindayna8
1 Ibn Sina National College, 2 King Saud Bin Abdulaziz University for Health Sciences,
3 Bayan Clinic, 4 Primary Health Care, 5 Majma'ah University, 6 King Fahad University Hospital,
7 King Khalid University, 8 King Hamad University Hospital (KHUH)
Corresponding Author: Taghreed Abdualaziz Almarshad - Toto-959@Hotmail.Com, Tel: +966 56 608 4136
ABSTRACT
Background: Acute pharyngitis is infection of the tonsils and the pharynx and is very common among children
and adolescents. They can be viral or bacterial in origin. The causative organism varies from geography, age, and
season of infection. Although viral pharyngitis is more common, the complications of bacterial pharyngitis can be
severe, and thus proper identification of the cause and management is very important.
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: acute pharyngitis, pediatric
pharyngitis, bacterial infection, streptococcus pharyngitis, viral pharyngitis, rapid strept test, throat culture
Aim: In this review, we aim to study the common causative organisms of acute pharyngitis among pediatric
population
and
study
the
best
course
of
management
that
must
be
followed.
Conclusion: Acute pharyngitis is a relatively common disease, with a viral cause most likely. An etiology due to a
streptococcal infection is a major concern and should always be ruled out due to its association with significant
morbidity and mortality. Long-term sequelae of streptococcal pharyngitis include rheumatic fever, rheumatic heart
disease, and acute post-streptococcal glomerulonephritis
Keywords: acute pharyngitis, pediatric pharyngitis, bacterial infection, streptococcus pharyngitis, viral
pharyngitis.
INTRODUCTION
Infection of the tonsils and the pharynx is called
rule out the disease in cases of negative results,
acute pharyngitis. This is very common to occur
especially in a highly suggestive clinical presentation
among children up to adolescence, and is due to
[2].
various organisms. These organisms are highly
related to several factors including epidemiology,
METHODOLOGY
geographical distribution, age, and season. Patients
· Data Sources and Search terms
may present with sore throat that is associated with
We conducted this review using a comprehensive
tonsillitis,
nasopharyngitis,
and/or
search of MEDLINE, PubMed, and EMBASE,
tonsillopharyngitis. These findings along with
January 1985, through February 2017. The following
rhinorrhea are strongly suggestive of a viral etiology.
search terms were used: acute pharyngitis, pediatric
However, it is not proper to distinguish between
pharyngitis, bacterial infection, streptococcus
different etiologies (bacterial, viral, or noninfectious)
pharyngitis, viral pharyngitis, rapid strept test, throat
based solely on the physical examination. Untreated
culture.
group A beta hemolytic streptococcus (GABHS) will
The study was done after approval of ethical
strongly predispose to rheumatic fever, which makes
board of King Saud Bin Abdulaziz university.
accurate diagnosis and management a major concern
especially in children older than two years [1]. In order
· Data Extraction
to prevent this, it is recommended to administrate
Two reviewers have independently reviewed the
antibiotics within the first nine days following
studies, abstracted data, and disagreements were
symptoms. To confirm the diagnosis, GABHS rapid
resolved by consensus. Studies were evaluated for
antigen detection assays provide a method that has a
quality and a review protocol was followed
specificity of 99%. However, it has a relatively low
throughout.
sensitivity (about 70%) which makes it difficult to
2000
Received: 20/12/2017 DOI: 10.12816/0044857
Accepted: 30/12/2017
c:\work\Jor\vol7011_24
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2004-2007
Crohn's Disease: Pathophysiology, and Management
Dima Ammar Fatahi1, Abdullah Saad Al Asmari2, Ghadah Abdulrahman Bukhari3,
Homoud Abdulaziz Alshamrani4, Khalid Abdullah Hunaydi5, Ahmad Mufarreh Sharahili5,
Tahani Khalid Alharshan6, Anhar Ali Alherz7
1 Tishreen University, 2 Taif University, 3 Ibn Sina National College, 4 Primary Health Care Center,
Riyadh, 5 Aseer Central Hospital, 6 King Faisal University, 7 King Faisal General Hospital
Corresponding Author: Dima Ammar Fatahi - dima.fatahi@gmail.com - 0540611988
ABSTRACT
Background: The incidence of crohn's disease reaches up to 20 per 100,000 people per year, with a median age
of 30 years, and is higher in the developed world. Although the exact cause and pathophysiology is unknown,
several environmental and genetic factors have been linked with higher risk or severity of the disease.
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: crohn's disease, inflammatory
bowel disease, genetics of crohn's disease, diagnosis of IBD, management crohn's disease
Aim of the study: In this review, we aim to study the pathophysiology, diagnosis and management of crohn's
disease. We will pay special attention to the newer biological drugs used in management.
Conclusion: Crohn's disease is usually managed with medical treatment, although many patients will need to
undergo surgery at least once. Treatment usually aims at the induction and maintenance of a remission without the
excessive use and dependence of steroids. Achieving higher quality of life is the main goal of any modality of
treatment.
Keywords: Crohn's disease, inflammatory bowel disease, medical management for crohn's disease.
INTRODUCTION
In 1932, Dr. Burril Crohn and his team
following search terms were used: crohn's disease,
described `crohn disease' for the first time. Crohn
inflammatory bowel disease, genetics of crohn's
disease is considered an inflammatory bowel disease
disease, diagnosis of IBD, management crohn's
`IBD' with idiopathic etiology and chronic nature.
disease.
Recent reports have found IBDs to attack more than
· Data Extraction
1 percent of the general US population.
Two reviewers have independently reviewed the
The incidence of crohn disease can reach 20 per
studies, abstracted data, and disagreements were
100,000 person-year, with a median age of 30 years.
resolved by consensus. Studies were evaluated for
It has a bimodal distribution with a pick at twenties
quality and a review protocol was followed
and another around fifties. The prevalence and
throughout. The study was done after approval of
incidence of crohn disease is higher in the developed
ethical board of Taif university.
world (like North America and Western Europe)
than developing world (like South America and
Etiology
Asia) [1]. It is slightly higher among women and
The exact etiology is still unknown, and the most
tends to have higher incidence among Ashkenazi
famous hypothesis suggests that crohn disease is an
Jewish. Until now, it is still not known how crohn's
autoimmune disease that attacks individuals with
disease develops and what causes the observed
genetic susceptibility.
pathological
findings.
However,
several
The onset of the disease was found to be
environmental and genetic factors have been linked
influenced by environmental exposures that affect
with higher risk or severity of the disease [2].
the natural balance of the gut flora, alter the mucosal
protection, and stimulate abnormal immune
METHODOLOGY
responses in the GI tract. Gut flora (microbiota), gut
· Data Sources and Search terms
immune response, and genetic predisposition, all
We conducted this review using a comprehensive
work together with the environmental factors to
search of MEDLINE, PubMed, and EMBASE,
develop crohn's disease [3].
January 1988, through February 2017. The
2004
Received: 20/12/2017 DOI: 10.12816/0044858
Accepted: 30/12/2017
Multiple sclerosis Misdiagnosis
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2008-2015
Approach in Diagnosis and Management and Common
Mistakes in Diagnosis of Multiple Sclerosis
1Anas Rafik Mohamed Elshaer, 2Mohamed Ahmed Hassan Kallab,
2Shurouq H. S. Alqrinawi, 3Osama Ahmed Abdelsalam
1King Fahad Hospital, 2Dammam Medical Complex ,3Neurology Department, Mansoura University
Corresponding author h e , E-mail: ashaer93@yahoo.com
ABSTRACT
Background- ugu tu d'E te, the g d o of E g d' Ki g Geo ge III, i now thought to have MS based
on a diary he kept until his death in 1848, in which he described symptoms that sound much like MS,
including blurred vision, weakness and numbness in his limbs, tremors and nocturnal spasms. Twenty years
fte d'E te' de th, the P i i eu o ogi t Je -Martin Charcot was the first to identify and name MS. A
fem e p tie t of Ch cot' was suffered from tremors, slurred speech and abnormal eye movements. He
attempted to treat her, but with o v i . fte he de th, Ch cot ex mi ed the p tie t' b i d di cove ed
the telltale plaques of MS the hardened scar tissue around nerve fibers. He was concerned with the discovery
of MS. Aim of the work: multiple sclerosis is considered as one of the great imitators as it features various
nonspecific symptoms such as sensory loss, spinal cord symptoms (Motor and autonomic), cerebellar
symptoms, eye symptoms, optic neuritis, trigeminal neuralgia, psychiatric as well as constitutional symptoms
and may be confused with a number of other diseases. In this project we aimed to identify problems and
mistakes for diagnosis of MS in order to achieve early diagnosis and prevention of misdiagnosis and
advancement of the disease. Patients and Methods: we have collected data about cases of multiple sclerosis
disease from two major hospitals in Saudi Arabia (Saudi German Hospital, Madinah, Dammam Medical
Complex, Dammam) during the year 2017. Among these cases we found 4 cases misdiagnosed as multiple
sclerosis. The first case 48 years old female diagnosed with multiple sclerosis and treated with Imuran for 8
month with no benefit then patient came again with the same symptoms and MRI done for him with no change
in MRI findings, thus the patient condition was not fit for the diagnostic criteria of multiple sclerosis and
diagnosed as primary lateral sclerosis. Second case 37 years old patient came with acute onset paraplegia and
diagnosed as transverse myelitis then came after 4 months; the patient developed symptoms of optic neuritis.
The third case 42 years old female came with left sided hemiplegia and diagnosed as ischemic stroke and
treated with vascular therapy without benefit then came again after 6 months with right sided hemiplegia and
incoordination then diagnosed as multiple sclerosis. Fourth case 30 years old female came with acute
diminution of vision and diagnosed as optic neuritis and treated without benefit then patient came again with
the same presentation and diagnosed as clinically isolated syndrome. Results: MRI findings are not enough in
diagnosis of multiple sclerosis and should be accompanied by good clinical expertise; lab tests as well as
exclusion of any other condition could be misdiagnosed as multiple sclerosis. Conclusion: multiple sclerosis
(MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous
system, destroying the myelin and the axon in variable degrees and producing significant physical disability
within 20-25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur
months or years apart and affect different anatomic locations.
Keywords: multiple sclerosis, misdiagnosis, immune modulatory, MacDonald criteria.
INTRODUCTION
acquired contributory components. An infectious
Multiple sclerosis (MS) is an immune-mediated
agent (i.e EBV) or at least a catalyst, has long been
inflammatory disease that attacks myelinated axons
suspected due to the geographic distribution and
in the central nervous system (CNS), destroying
presence of clusters of cases; however, no agent
the myelin and the axon in variable degrees. In
has yet been firmly confirmed (3). A study also
most cases, the disease follows a relapsing-
suggested that chronic cerebrospinal venous
remitting pattern, with short-term episodes of
insufficiency can cause or exacerbate MS but this
neurologic deficits that resolve completely or
theory has not been proven by further
almost completely. A minority of patients
investigations (3). Multiple sclerosis is believed to
experience are steadily progressive neurologic
result from a cell-mediated autoimmune response
deterioration (1,2).
against one's own myelin components, with loss
of oligodendrocytes, with little or no axonal
Pathology
degeneration in the acute phase; however, in later
The exact aetiology is poorly known
stages, loss of oligodendrocytes results in axonal
although it is believed to have both genetic and
degeneration. Demyelination occurs in discrete
2008
Received: 20/12/2017 DOI: 10.12816/0044859
Accepted: 30/12/2017
c:\work\Jor\vol7011_26
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2016-2018
Case of Idiopathic Peripapillary Subretinal Neovascular Membrane in an
otherwise Healthy Young Male: A Case report
Raed Awadh Alharthi, Ashwaq Mohammed Almalki, Faisal Ali Alotibi, Hatim Fozi Jabr.
Department of Ophthalmology, King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia.
Corresponding author: Raed Awadh Alharthi, E-mail: R.alharhi92@gmail.com
ABSTRACT
Aim of work: this study aimed to report a rare case of idiopathic peripapillary subretinal neovascular
membrane (PCRNVM) in an otherwise healthy young male
Patient and method: this was a case report study of 31-years old healthy male came to ophthalmology clinic
complaining of blurred vision.
Result: fundus examination revealed left idiopathic peripapillary subretinal neovascular membrane
(PCRNVM) and its presence was confirmed by optical coherence tomography (OCT) and fundus fluorescein
angiography (FFA).
Conclusion: idiopathic peripapillary subretinal neovascular membrane(PSRNVM)is rare condition in healthy
young with no predisposing factors and our case was responded well to single dose of Anti-VEGF
(ranibizumab).
Keywords: subretinal neovascular membrane, ranibizumab, peripapillary.
INTRODUCTION
Idiopathic peripapillary subretinal neovascular
There was no history of pain and he denies
membrane(PCRNVM) is one of the types of
preceding trauma, photophobia ocular discharge,
choroidal neovascular membranes (CNVMs)
tearing or prior eye surgery. Best corrected visual
characterized by collection of abnormal blood
acuity (BCVA) was 20/20 in the right eye and
vessels originating from choroid via break in bruch
20/40 in the left eye. A planation tonometer was
membrane and located adjacent to the optic disc. It
normal bilaterally. By bilateral slit lamp
is typically found in patients older than 50 years
examination there were no keratic precipitates and
who are affected by exudative age-related macular
the anterior chamber was deep quiet with no cells
degeneration (AMD) [1]. PCR-NVM is usually
or flare. Vitreous cavity was quiet and clear.
associated with predisposing conditions, such as
Funduscopic examination of the left eye (OS)
multifocal choroiditis, angoid streak, punctate inner
revealed a juxtapapillary peripapillary subretinal
choroidopathy, congenital (disc anomaly), optic
neovascularization at the level inferotemporal
disc
drusen,
trauma
(choroidal
rupture),
arcade associated with chorioretinal folds, retina
inflammation
or
infections
(histoplasmosis,
pigment epithelium atrophy, marked retinal edema
sarcoidosis) choroidal tumors (osteoma) and very
and hard exudate involving optic disc, macula and
few cases of PSRNVM without detectable cause
papillomacular bundle (Fig 1a). FFA showed
called (Idiopathic) [2]. Nowadays, intravitreal anti
hypoflourescence area due to obstruction of the
VEGF is the mainstay of treatment for CNV [3]. The
background by hemorrhage and exudate (Fig 1b).
visual outcomes are promising and procedure
The right eye (OD) was unremarkable.
generally well tolerated [4]. In this study, we
Screening blood test was done to exclude
reported an idiopathic peripapillary subretinal
antecedent causes CBC, inflammatory markers
neovascular membrane in a 31-year-old healthy
(CRP, ESR) Mantoux test, RA factor, TORCH
male patient with no evidence of predisposing
titres, RPR(VDRL), HIV, serum calcium and all
factor and responded well with Anti-VEGF
results were normal.
(ranibizumab).
He was treated with intravitreal ranibizumab
The study was done after approval of ethical
(0.05 ml of 10 mg/ml) after obtaining a written
board of King Abdul-Aziz Specialist Hospital.
informed consent from him. At 4-week follow-up,
BCVA in the left eye improved to 20/20. Fundus
CASE REPORT
examination of the left eye revealed regression of
31-year-old
healthy
male
came
to
PSRNVM with moderated resolution of subretinal
ophthalmology clinic (King Abdul-Aziz Specialist
fluid (Fig1 C). OCT revealed moderate reduced of
Hospital, Taif Saudi Arabia) complaining of blurred
subretinal fluid (Fig 2b). The patient has scheduled
vision in his left eye over the last three months.
for more Anti-VEGF injection in next every 4-week
follow-up visit until full resolution of edema.
2016
Received: 20/12/2017 DOI: 10.12816/0044860
Accepted: 30/12/2017
c:\work\Jor\vol7011_27
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2019-2021
Emergency Management of Subdural Hematoma
Abdulrahman Mubarak Almutairi1, Hassan Mohammed Barnawi2,
Ebtesam Mohammed Alahmari3, Tahani Saeed Almohayya3, Roaa Fahad Alshabanah3,
Huda Hussain Mohammad Radwan4, Muath Ahmad Al-Gadouri5
1 Majmaah University, 2 Taibah University, 3 King Khalid University,
4 Ibn Sina National College, 5 Umm Alqura University
Corresponding author: Abdulrahman Mubarak Almutairi - a.m.almutairi@live.com - 0564804048
ABSTRACT
Background: Subdural hematoma is extra-cerebral accumulation of blood between the dura matter and the
subarachnoid layer. It is almost always caused by trauma or due to blood thinning therapies, and occurs due to
rupture of bridging veins. Acute subdural hematoma is an emergency situation and requires prompt diagnosis using
CT most of the time, and management requires surgery as well as reversal of anticoagulants.
Materials and methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 1985, through February 2017. The following search terms were used: subdural hematoma,
emergency management of subdural hematoma, CT vs. MRI in diagnosis of subdural hematoma, treatment of
subdural hematoma. Aim: In this review, we aim to study the etiology of subdural hematoma, explore how to
diagnose and manage it in the emergency department Conclusion: Subdural hematoma is an important clinical
presentation that needs proper and prompt surgical management and treatment. Treatment should be as less
invasive as possible, with higher efficacy and lower recurrence rates. Non-surgical approaches are still being
studied with no proven efficacy for them until now.
Keywords: subdural hematoma, diagnosis in emergency room for subdural hematoma, CT vs. MRI, management
of subdural hematoma
INTRODUCTION
Extra-cerebral accumulation of blood (whether
METHODOLOGY
liquid or clotted) between the dura matter and the
· Data Sources and Search terms
subarachnoid layer is called subdural hematoma. This
We conducted this review using a comprehensive
hematoma does not cause an expansion of the
search of MEDLINE, PubMed, and EMBASE,
subarachnoid area. The cause of this hematoma is
January 1985, through February 2017. The following
almost always trauma. Hematoma will cause an
search terms were used: subdural hematoma,
accumulation that will lead to compression of the brain
emergency management of subdural hematoma, CT
and focal neurological manifestations.
vs. MRI in diagnosis of subdural hematoma, treatment
Moreover, it causes an increase in intracranial
of subdural hematoma.
pressure (with subsequent sequelae) and can affect
The study was done after approval of ethical board
consciousness [1]. The classification of subdural
of Majmaah university.
hematomas depends mainly on the time relapsing
between the causing of the trauma and the onset of
· Data Extraction
clinical signs and symptoms. Subdural hematomas can
Two reviewers have independently reviewed the
be classified as the following [2]:
studies, abstracted data, and disagreements were
solved by consensus. Studies were evaluated for
Acute subdural hematoma: onset of clinical signs and
quality and a review protocol was followed
symptoms is within three days following trauma.
throughout.
Subacute subdural hematoma: onset of clinical signs
and symptoms is within 4-21 days following trauma.
Etiology
Chronic subdural hematoma: onset of clinical signs
Subdural hematomas constitute up to 3% of cases
and symptoms is after more than 21 days following
presenting to neurosurgery clinics, and are most likely
trauma.
due to preceding trauma. Usually, trauma causing
subdural hematoma is minor, anteroposterior, and is
associated with emissary veins rupture. The long term
2019
Received: 20/12/2017 DOI: 10.12816/0044861
Accepted: 30/12/2017
c:\work\Jor\vol7011_28
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2022-2024
Nasal Polyps and its Histo-pathological Evaluation
Bayan Sultan Al Jobran, Atheer Eed Alotaibi, Ashwaq Y. Asiri,
Roqayya Mohammad Alhayyani, Norah Ibraheem Almanie
King Khalid University
Corresponding Author: Bayan sultan al jobran - Bayansu93@hotmail.com - 0530134291
ABSTRACT
Background: Nasal polyposis are considered a sign or a physical finding rather than a disease resulting from a
complex process that is found in some individuals, such as people suffering from chronic sinusitis, rhinitis,
Kartagener's syndrome, or cystic fibrosis. Sinonasal polyps can have four distinct histological subtypes, which
include eosinophilic polyp, chronic inflammatory polyp, hyperplastic polyp, and polyp with stromal atypia.
Aim: In this review, we aim to study the presentation, classification and diagnosis of nasal polyps in the light of
histopathological findings. 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: nasal polyp, inflammation of nasal mucosa, chronic inflammation, histology of nasal mucosa, pathology of
nasal polyps. Conclusion: Polyposis does not have histological problems and complications. However, they may
be clinically disturbing. Polyps are not classified into allergic and non-allergic, and are rather stratified according
to histological findings, making histological investigation crucial for diagnosis.
Keywords: nasal polyp, ENT pathology, chronic inflammation, histology of nasal mucosa, pathology of nasal
polyps.
INTRODUCTION
The word `polyp' originates from Greece where
about 30% of patients who had never suffered from
it mean `many feet', which indeed can describes
any symptoms during their lives [2].
pathogenesis of nasal polyps. Nasal polyposis can be
considered a sign or a physical finding rather than a
No evidence is present to support the association
disease. This sign is the result of a complex process
between atopic allergy and nasal polyposis, and both
that is found in some individuals.
atopic and nonatopic adults can suffer from nasal
A recent publication by the European Academy
polyps, with similar prevalence in both populations.
of Allergology and Clinical Immunology and
However, up to 32.6% adults with nasal polyps report
European Rhinologic Society, reported that nasal
at least an attack of asthma or bronchospasm.
polyposis can be counted as a subtype of chronic
Moreover, 85% of asthmatics on steroids were shown
rhinosinusitis [1].
to have sinus abnormalities on CT. Patients who
When conducting studies on the histology of
suffer from asthma can have double the risk of
nasal polyps, it was found that it was the result of
developing polyps when they are compared with
extracellular fluid accumulation, a mild inflammatory
patients without asthma, and nonallergic asthma
process, and proliferation of mucosa and submucosa
(13%) is associated with a higher risk than allergic
within the perinasal sinus or the turbinates. Adults are
asthma (5%). The previous results have led to the
more likely to develop nasal polyps than children,
suggestions that allergy does not predispose to
and the presence of nasal polyps in children usually
polyps, but bronchial asthma does. Additionally,
indicates an underlying Kartagener syndrome (cilia
patients who have aspirin hypersensitivity along with
dyskinesis syndrome) or cystic fibrosis.
asthma, have polyps in up to 90% of cases, which is
On the other hand, chronic sinusitis or rhinitis
known as the `aspirin triad'. Another relatively rare
are common causes in adults. The prevalence of nasal
entity of nasal polyps is antrochoanal polyps, which
polyposis has been found to be up to 4.3% of adults,
constitutes about 5% of all polyps. The formal type is
which is near to the prevalence of several other
more likely to be found in males, asthmatics, or
diseases like chronic obstructive lung disease,
patients with primary ciliary dyskinesia, Churg-
diabetes, and asthma. However, many researchers
Strauss Syndrome, cystic fibrosis, Young syndrome,
argue that these numbers are overestimated and the
or inherited or acquired anatomical abnormalities of
real prevalence may be less. Some studies on
sinuses or nasal cavity [3].
autopsies, have interestingly found nasal polyps in
2022
Received: 20/12/2017 DOI: 10.12816/0044862
Accepted: 30/12/2017
c:\work\Jor\vol7011_29
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2025-2028
Respiratory Aspects of Approach to Neonatal Resuscitation
Rayan Abdulbasit Marzuqi1, Waleed Abdulaziz Almosfer2, Yara Mofarih Assiri3,
Ali Adnan Al Khamis4, Trad Abdulaziz Alasiri5, Mayar Khalid Shaffei5, Rahaf Emad Hejazi5,
Zainab Habib Almomen6, Arwa Mohammed Aldosari7
1 King Abdulaziz University, 2 Majma'ah University, 3 King Khalid University,
4 Al Jaber Hospital ENT & OPH, 5 Umm Alqura University,
6 Imam Abdulrhman Al Fisal University, 7 Fatima Jinnah Medical College in Pakistan
Corresponding Author: Rayan Abdulbasit Marzuqi
ABSTRACT
Introduction: Around 10% of live births globally require immediate intervention, and 4 million neonatal deaths
happen in a year, where one fourth of them are due to asphyxia. Regular respiration may fail to achieve
spontaneously in about ten percent of live births, with one percent of cases needing resuscitation with chest
compressions, and about 0.06% needing epinephrine. The target in neonatal resuscitation is to achieve sufficient
functional residual capacity, while avoiding pulmonary damage, and to optimize the tissue delivery of oxygen
without causing toxicity
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: neonatal asphyxia, neonatal
resuscitation, neonatal intensive care, respiratory distress syndrome, complications of prematurity, oxygen therapy,
neonatal ventilation
Aim: In this review, we aim to study the various approach taken to provide immediate resuscitation to neonates
with respect to respiratory distress.
Conclusion: With advancing research, physicians should have more devices to decrease the mortality rates among
infants. We also need more research to establish best recommendations and guidelines on the use of best
interventions especially in clinical setting with limited resources.
Keywords: neonatal resuscitation, neonatal intensive care, respiratory distress syndrome, complications of
prematurity, oxygen therapy, neonatal ventilation, neonatal asphyxia.
INTRODUCTION
METHODOLOGY
It is estimated that about 10% of live births
· Data Sources and Search terms
worldwide will need an immediate intervention
We conducted this review using a comprehensive
following birth. Four million neonatal deaths occur
search of MEDLINE, PubMed, and EMBASE,
annually, with about a quarter of them as a result of
January 1986, through February 2017. The following
asphyxia [1]. Infants' adaptation to extrauterine life
search terms were used: neonatal asphyxia, neonatal
normally occurs through physical transition, but needs
resuscitation, neonatal intensive care, respiratory
external help in most cases to be achieved without
distress syndrome, complications of prematurity,
complications. This adaptation happens through
oxygen therapy, neonatal ventilation
respiratory and circulatory changes. Regular
· Data Extraction
respiration may fail to achieve spontaneously in about
Two reviewers have independently reviewed the
ten percent of live births, with one percent of cases
studies, abstracted data, and disagreements were
needing resuscitation with chest compressions, and
resolved by consensus. Studies were evaluated for
about 0.06% needing epinephrine [2].
quality and a review protocol was followed
To understand the physiology of neonatal
throughout.
resuscitation, there has been significant research in this
The study was done after approval of ethical board
field, with multiple attempts to establish new
of King Abdulaziz university.
guidelines and recommendations that will lead to
better outcomes at birth. The target in neonatal
Ventilation
resuscitation is to achieve sufficient functional residual
Fetal lung fluid and first breaths
capacity (FRC), while avoiding pulmonary damage,
To reach proper in-utero lung development, it is
and to optimize the tissue delivery of oxygen without
critical to maintain the active secretion of chloride.
causing toxicity.
Late in pregnancy, mechanisms responsible for the
2025
Received: 20/12/2017 DOI: 10.12816/0044863
Accepted: 30/12/2017
c:\work\Jor\vol7011_30
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (11), Page 2029-2037
Assessment of Customer Satisfaction with the Clinical Laboratory Services
Provided in King Abdullah Medical City, Makkah
Daliah Almatrafi1, Najwa Altaweel2, Mona Abdelfattah2, Abdulrahman Alomari1, Waed Yaseen1,
Mohannad Alsulami1, Fatima Abonaji1, Moayad Alqazlan3, Hussam Darrar4.
1 Faculty of Medicine, Umm Alqura University, 2 Laboratory and Blood Bank Department,
King Abdullah Medical City (KAMC), 3 Faculty of Medicine, Alqassim University.
4 Faculty of Pharmacy, Umm Alqura University
Corresponding author: Daliah Almatrafi, E-mail: daliah.matrafi@gmail.com
ABSTRACT
Background: Patients and physicians are considered primary customers of laboratory services. Therefore,
assessing customer satisfaction with laboratory services is an essential indicator in improving
the quality of laboratory services. Objectives: This study measures the level of satisfaction of physicians and
patients who avail of the clinical laboratory and phlebotomy services, respectively, at the outpatient
department (OPD) in King Abdullah Medical City (KAMC), to evaluate the possible issues and carry
out corrective actions. Methods: A cross-sectional survey to evaluate the level of satisfaction using a
modified patient and physician questionnaires, the patients were randomly selected and interviewed in
phlebotomy areas at the outpatient and chemotherapy clinics. A paper-based questionnaires were
distributed to all physicians all available physicians in KAMC who were regularly requiring laboratory
investigations. The collected data were coded, entered, and checked for outliers or missing data and analyzed
using the SPSS statistical package version 21. Results: A total of 435 patients were interviewed and their
mean satisfaction was 4.51±0.32 out of 5. Respondents were satisfied with the Availability of laboratory tests.
However, they were dissatisfied with Explanation of the phlebotomy cautions by the phlebotomist (75.4%).
Twenty eight percent of physicians (132) participated, their mean satisfaction rate was 3.6±0.7 out of 5. The
greatest satisfaction rate was related to critical results notification and the communication with laboratory
personnel. Physicians were most dissatisfied with both specimen delivery process and incorrect test results.
Conclusion: Both customers were satisfied with the laboratory service provided for them. Factors as
"Explanation of the phlebotomy process by phlebotomist" and "specimen collection and delivery process"
received lowest satisfaction score for patients and physicians respectively. Therefore, improving them is
required to meet the needs of the customers and gain their satisfaction regarding the service.
Keywords: Laboratory, Customer, satisfactions, services.
INTRODUCTION
The clinical laboratory services of a healthcare facility
in the city of Riyadh measuring the patients' level of
play anessential role in making appropriate medical
satisfaction in general [7]. In 2015, a study was
decisions for patient's health [1]. The concept in
conducted in Maternity and Children Hospital in
improving the quality of laboratory services
Makkah focusing on the physician's satisfaction with
considering the customer's perspective on the services
the laboratory services [1]. The lack of research aimed
provided to them has become more prevalent in the
at measuring the customer's satisfaction with the
later decades [2]. Therefore, assessing customer
laboratory services in Saudi Arabia inspired us to
satisfaction with laboratory services is an essential
establish this study. Our study aimed to evaluate the
indicator in improving the quality of laboratory
level of satisfaction of physicians and patients who
services. The Joint Commission on Accreditation of
avail of the clinical laboratory and phlebotomy
Healthcare Organizations and the College of American
services, respectively, at the outpatient department
Pathologists (CAPs) give accreditation to clinical
(OPD) in King Abdullah Medical City (KAMC) and to
laboratory programs. The CAPs require the healthcare
address the possible issues to carry out corrective
facility to measure customer satisfaction with the
actions.
laboratory services every two years [3,4]. The healthcare
system in Saudi Arabia has greatly improved.
METHODS
However, the customers' perspective regarding the
A cross-sectional survey was conducted in King
healthcare services in general still remains unclear, and
Abdullah Medical City (KAMC), Makkah, Saudi
only a few studies have been conducted to measure the
Arabia from June 1 to June 30, 2015 measuring the
level of customer satisfaction[5]. In 2009, a study was
level of satisfaction of customers who availed of the
done to measure the overall satisfaction of Arab
hospital's clinical laboratory services. Specifically, we
patients about the services provided by primary health
performed customer satisfaction surveys to evaluate
care centers in the city of Makkah during Hajj season
the level of satisfaction of physicians and outpatients
[6]. Previously, in 1993, a similar study was conducted
who availed of the clinical laboratory and phlebotomy
2029
Received: 20/12/2017 DOI: 10.12816/0044864
Accepted: 30/12/2017