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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2029-2033
Coexistence of Prehypertension and Hypertension and
Obesity in Young Adults in Arar, Saudi Arabia
Rawan Wadi Alanazi1, Abdulelah Aziz Eissa Alenzi1, Sarah Musharraf Alanazi1,
Fahad Mubarak Fahad Alqahtani 2, Ali Hamdan Mohammed Alharbi3,
Abdullah Saeed Saad Al muhammisah4, Fahad Ayesh E Almutairi5, Abdulaziz Mohammed R
Almasoud1, Ibrahim Meqbel Alanazi1, Hisham Hamad Alameer6, Bassam Wadi Alanazi1
1 Faculty of Medicine, Northern Border University, 2 Ramah Hospital, Riyadh,
3 Maternity and Child Hospital, Prada, KSA, 4 Almaarefa College for Science and Technology, Riyadh,
5 Security Forces Hospital in Riyadh, 6 University of Debrecen, Hungary
ABSTRACT
Background: Obesity often coexists with hypertension (HTN) and a linear relationship between blood
pressure (BP) values and weight was observed.
Objective: The aim of this study was to determine the prevalence rate of prehypertension and hypertension
and to estimate the coexistence of prehypertension and hypertension and obesity in young adults in Arar,
Saudi Arabia.
Materials and methods: This was a cross sectional study. The study subjects were selected from health
young adults attending 5 randomly selected primary health care centers in Arar city, the capital of the
Northern Province of KSA. Participants were given a predesigned and pretested questionnaire to collect the
relevant data.
Results: Among the studied participants, Fifty (52.1%) of females and 58.8% of males were pre-
hypertensive and 1.5% from males were hypertensive. 37.9% of the studied participants were obese and
same percentage were overweight. 18.2% of obese were hypertensive or pre-hypertensive and 40.9% of
overweight were hypertensive or pre-hypertensive. While 3% of the underweight were hypertensive or pre-
hypertensive and 3% were not (P<0.05).
Conclusion: in young adults in Arar, KSA. 37.9% of the studied participants were obese and same
percentage were overweight. About half of females and more than half of males were pre-hypertensive and
small percentage of males were hypertensive. Obesity was associated with pre-hypertension and
hypertension. So education sessions should be carried out to educate the public specially adolescents and
young adult population.
Keywords: Prehypertension, Hypertension, Obesity, Overweight, Young adults.
INTRODUCTION
overweight adults around the globe was 396
Obesity often coexists with hypertension
million and 937 million respectively [6]. In Saudi
(HTN) and a linear relationship between blood
Arabia a national study was conducted in 1998 to
pressure (BP) values and weight was observed [1].
determine the prevalence of hypertension among
Obesity increases the risk of the development of
the adult population. It revealed that its
hypertension. This linkage has been the subject of
prevalence was higher among males (18.7%) than
several recent reviews [2, 3]. Hypertension, a non-
females (14.0%) and was highest in the Eastern
communicable
cardiovascular
disease
has
province [7]. Another recent national study done
become one of the leading cause of morbidity and
in 2007 reported a higher prevalence rate of
mortality throughout the world. The seventh
hypertension among Saudi adults (28.6% for
report of the joint national committee on
males and 23.9% for females), indicating a rising
prevention, detection, evaluation and treatment of
trend in hypertension in Saudi Arabia [8]. An
high blood pressure (JNC7) defined hypertension
attempt was made in the present investigation to
as blood pressure >140/90 mmHg [4], when
determine the prevalence of and correlation
prehypertension was defined as individuals with
between HTN and obesity among the adults in
blood pressure (BP) above optimal levels, but not
Arar
city,
northern
borders
Saudi
clinical hypertension [5].
Arabia. Moreover, we aimed to determine risk
Obesity, genetic factors, sedentary life style
factors of these conditions including smoking,
and family history are the most common risk
lifestyle behaviors, dietary factors, and family
factors of hypertension and other cardiovascular
history.
disorders. Over the last few decades, obesity has
become a global public health concern. In 2005,
Objectives:
the estimated total number of obese and
2029
Received: 20/12/2017 DOI: 10.12816/0045025
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2043-2050
Medical Students' Attitude and Perception towards Basic Medical
Sciences in the Faculty of Medicine for Girls, Al-Azhar
University: A Study Prior to the Integrated Program
Reda El-Belbasy1, Enas K. Abo-Elmagd2, Mona Abd-Rabo3
Departments of Community Medicine1, Microbiology2 and Parasitology3
Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt
1Corresponding author: Ass. Prof. Dr. Reda El-Belbasy, E-mail: delbelbasy@yahoo.com
ABSTRACT
Background: Assessment of the students' opinion throughout their teaching course is a crucial part to achieve the
intended learning outcome. Objectives: Were to assess and compare the students' attitude and perception towards
basic medical sciences during the preclinical and clinical academic years, to recognize their opinion to early
integration of both basic and clinical sciences, their preferred basic subjects and related causes.
Subjects and Methods: A cross sectional study was conducted on 344 female medical students. They were
randomly selected through the academic year 2015-2016, at the Faculty of Medicine for Girls, Al-Azhar
University in Cairo. Data were collected using a valid and reliable (nine items) questionnaire. The first five items
measured the perceived importance and relevance of basic medical sciences to clinical medicine, and the last four
items measured students' attitudes towards, and perceived effectiveness of their education in basic medical
sciences. Necessity of integration from the first year and the preferred basic medical subjects were also asked
about. All opinions were rated using a three points Likert scale. Results: A significant difference between the two
groups was obtained as regards that "physician can effectively treat most medical patients without knowing the
details of the biological processes (72.4% versus 75.9%). While, disagreement perception was significantly higher
among clinical group students (62.8%) compared to preclinical students (47.8%) as regards less value of basic
medical sciences in clinical practice. Modest agreement attitude was the dominant towards the further statements
with no significant difference (p>0.005). How best to integrate both clinical and basic medical sciences was not
significant and represented 67.5% and 71.0% among preclinical and clinical students respectively. The top
preferred basic medical sciences were; anatomy, physiology and pathology. Understandable curriculum, good
professor and clear method of teaching were the main causes for preference. Conclusion and Recommendation:
Overall positive attitude and perception towards basic medical sciences are found, mainly among students in
clinical years. Refocusing the basic/clinical medical sciences is essential to cross the gap between knowledge and
medical practice. Opinion of the students is necessary to be considered to provide the educational planners with
valuable guidelines in order to maximize the benefits of medical curricula and prepare medical students efficiently
for clinical work. Further studies prior to the application of the integrated program are required.
Keywords: Medical students, basic medical sciences, attitude, perception, integration discipline.
INTRODUCTION
considered in medical education to cross the gap
The
national
movement
toward
between knowledge and practice such as; quality of
redesign of medical collage's curricula nowadays
learning process, curriculum content, methods of
necessitates re examination of all aspects of medical
teaching and continuous evaluation (4). In addition, in
education program, including the role of the basic
the last two decades, integration curriculum in
medical sciences for the practice of medicine.
medical education is a challenging approach to
Medical students build their clinical knowledge on
remove distinction between basic and clinical
the grounds of previously obtained basic knowledge
subjects (5). Little is known about opinion and
(1). Moreover, most scientific knowledge learned in
response of medical students about curriculum
preclinical academic years play a role through
provided to them, either a collection of separate
progress of the student from understanding into
subjects or an integrated and effective one topic (i.e.
action (2). It has been observed that basic science
medicine). Monitoring the attitudes and perception
knowledge learned in a clinical context is better
of medical students throughout their teaching course
comprehended and more easily applied by the
play a vital role in their learning process, better
students (3). Therefore, several elements need to be
achievements and future practice (4). It may provide
2043
Received: 20/12/2017 DOI: 10.12816/0045026
Accepted: 30/12/2017
PARASITIC PROFILE AMONG PRIMARY SCHOOL CHILDREN IN A RURAL AREA AT BEHEIRA GOVERNORATE
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2042-2049
Parasitic Profile among Primary School Children in
A Rural Area at Beheira Governorate, Egypt
Ahmed M. S. Bayoumy1, Mohamed A. Abd El Raheem2, Anwar H. Abo Hashim1,
Ahmed S. K. Al Saadawy2, Islam M. R. Al Karyony2
1. Department of Medical Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
2. Department of Medical Parasitology, Faculty of Medicine Al-Azhar University, Assiut, Egypt.
Corresponding author: Ahmed Bayoumy, email: drahmedbayoumy@azhar.edu.eg
ABSTRACT
Background: Parasitic infection is still a serious public health problem in the world, especially in developing
countries including Egypt. It represents a major cause of morbidity and mortality in childhood and among high-
risk groups in most parts of the world. Objectives: This study aimed to detect the prevalence of parasitic infection
and degree of anemia and eosinophilia among primary school children of two governmental schools in a rural area
at Damanhour Center, Beheira Governorate, Egypt during the period from October, 2016 to April, 2017.
Methods: Randomly chosen (600) students aged from (6 12) years, (394 males and 206 females were subjected
to: A questionnaire sheet, stool examination using: Direct smear and concentration techniques (formol ether
sedimentation and simple flotation), urine examination, NIH swab for diagnosis of E. vermicularis eggs as well as
complete blood count examination.
Results: The overall prevalence of parasitic infection reached 38.3% (27.8% in males and 10.5% in females) with
a prevalence rate of (22.5%), (12.8%) and (3%) for helminthic, ptotozoal and mixed infections respectively. The
identified parasites were E. vermicularis (11.8%), H. nana (7.2%), G. lamblia (6.8%), E. histolytica/dispar (6%),
S. mansoni (1.7%), A. lumbricoides (1.2%), T. trichiura (0.3 %) and S. haematobium (0.3 %) while, mixed
infection reached (3%). The eggs of E. vermicularis were found in both urine and stool specimens of three girls
only. Prevalence of anemia among all studied children reached (41.8%); (67.8%) in infected children compared to
(25.7%) in non-infected children while eosinophilia was (6%); (14.3%) in infected children compared to (0.8%)
in non-infected children with statistically significant difference. There was a significant correlation between
parasitic infection and headache, fatigue, pallor, loss of appetite, abdominal colic, perianal itching, diarrhea,
pitryasis alba, loss of weight and salivation during sleeping. Also, there was a significant association between
parasitic infection and some bad hygienic habits as un-proper hand washing and hygiene, swimming in canals, un-
trimming of finger nails and un-proper washing of vegetables and fruits.
Conclusion: Rural residency, bad hygiene and low social class were the most significant risk factors associated
with parasitic infections.
Keywords: Egypt, Beheira Governorate, Primary school children, Intestinal parasites, Rural community.
INTRODUCTION
of parasitic infections, but it was focused mainly on
Parasitic infections are a major public health
chemotherapy as a means of control while the study of
problem worldwide particularly in the developing
social, cultural and economic factors underlying
countries and constituting the greatest cause of illness
infection risk has been relatively neglected (5).
and disease (1). However, the prevalence of intestinal
The present study aimed to evaluate the prevalence
parasitic infections (IPI's) varies considerably from
of parasitic infection and association between it and
place to another in relation to the pattern of
different types and degrees of anemia and eosinophilia
transmission of the disease (2). In Egypt, enteric
among primary school children in a rural area at
parasitic infections still the cause of major health
Damanhour Center, Beheira Governorate, Egypt.
problems among Egyptian children as they have great
morbid effect on their physical and cognitive
MATERIALS AND METHODS
development and increased susceptibility to other
The present study was carried out in Beheira
infections (3). From health perspective, IPI's affect the
Governorate which is located at the Western part of
physical and mental wellbeing of school children
the Delta region, Egypt and conducted on (600)
thereby leading to increased absenteeism, retarded
primary school children aged between (6-12) years
cognitive development and thus learning disabilities
old of Al Mansheia; Al Ebrahemia and Abo Tabl
(4). In spite of the increased public health importance
primary schools which were located in a rural area at
Damanhour Center, during the period from October,
2042
Received: 20/12/2017 DOI: 10.12816/0045027
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2050-2057
Role and Incidence of Parasitic Infection in Adult
Egyptian Patients with Acute Appendicitis
Ahmed M. Bayoumy 1, Adel O. Seif Elnasr 1, Ibrahim A. Ibrahim 2,
Salah- EL-din S. Semary 3, Mahmoud R. Mohamed 1.
1 Department of Parasitology, Faculty of Medicine (boys), Al-Azhar University, Cairo,
2 Department of General Surgery, Faculty of Medicine (boys), Al-Azhar University, Cairo,
3 Department of General Pathology, Faculty of Medicine (Damietta), Al-Azhar University, Egypt
Corresponding author: Ahmed Bayoumy, E-mail: drahmedbayoumy@azhar.edu.eg
ABSTRACT
Background: Appendicitis is the most important acute surgical condition of the abdomen, and appendectomy
constitutes one of the most common surgical operations worldwide. Many factors can cause appendicitis but the
intestinal parasitic infections are one of the most important causes.
Objective: The present study aimed to evaluate and detect the role and incidence of various parasitic infections
in appendectomy specimens from Egyptian adult patients with acute appendicitis attending the General Surgery
Emergency room at Al-Azhar University Hospitals, Cairo, Egypt (Al-Hussein and Sayed Galal Hospitals).
Patients and methods: The present study was carried out on 200 patients undergoing appendectomy with a
provisional diagnosis of acute appendicitis during the period from December 2015 to November 2016. The
removed appendices were fixed in 10% buffered formalin, sectioned, stained with H&E and examined for
histopathological changes and presence of parasites. Stool examination was also done by direct smear, formol
ether concentration techniques as well as CBC examination for all patients.
Results: Stool examination revealed 120 (60%) out of the total 200 appendectomy patients were positive for
parasitic infections, while CBC examination revealed leucocytosis among 167 (83.5%), and eosinophilia in 40
(20%) as well as anemia in 43 (21.5%) in all the studied patients. Histopathological examination revealed
parasitic infections in 6 (3%) of appendectomy specimens. The presence of E. vermicularis worms and their eggs
as well as Schistosoma ova were observed in 4 (2%) and 2 (1%) of cases respectively. Features of acute
suppurative appendicitis were observed in 143 (71.5%) of cases, of which, 98 (49%) cases had luminal
obstruction by fecalith and 45 (22.5%) showed patent lumen. Non suppurative appendicitis were presented in 57
cases (28.5%) which included lymphoid hyperplasia in 21 cases (10.5%) and neuronal hyperplasia in 6 cases
(3%) as well as granulomatous appendicitis with features consistent with appendiceal Crohn's disease (CD) in 30
cases (15%). Conclusion: The study concluded that parasitic infections constitute 3% of the surgically removed
appendices where Schistosoma eggs and E. vermicularis (adults and eggs) were the parasites recorded. So
differential diagnosis of parasitic infections in the etiology of acute appendicitis should be made properly which
can save patients from a negative laparotomy, morbidity and even mortality.
Keywords: Appendicitis, Enterobius vermicularis, Schistosoma species, Histopathology, Parasitic infection,
Stool and CBC examination.
INTRODUCTION
stasis, fecaliths, lymphoid hyperplasia and foreign
Appendicitis is the most common cause of acute
bodies are the most common cause of appendiceal
abdominal pain that requires surgical treatment.
obstruction 1. Another important cause of
The prevalence of appendicitis is reported to be
appendicitis is parasitic infection but the actual
around 7%. It is more common in males than
role as co-factor in appendicitis is still to debate.
females (1.4:1) and can be seen at any age but it is
There is little evidence regarding the relationship
more commonly seen in older children and in
between parasites and acute appendicitis. In even
young adults. It is more common in urban,
tropical countries, where intestinal parasitic
industrialized societies and relatively rare in
infection is quite common, appendiceal disease is
developing countries where a less-refined, high-
not unusual 3. Obstruction of the appendiceal
fibre diet is typically consumed. Presumably, the
lumen can occur with parasites and their eggs. If
diet in industrialized countries leads to hard stool,
the lumen is obstructed, continued secretion and
higher intra colonic pressure and formation of
proliferation of bacteria or the parasites may cause
fecaliths that can serve as obstructing agents in the
an increase in the intra luminal pressure. Increased
appendiceal lumen 1. The cause of acute
pressure impairs the circulation of the wall and
appendicitis is unknown but is probably
mucosal damage may cause bacterial invasion,
multifactorial; luminal obstruction, dietary and
inflammation, sepsis and finally necrosis and
familial factors have all been suggested 2. Faecal
perforation 4. Most prominent parasitic agents
2050
Received: 20/12/2017 DOI: 10.12816/0045028
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2058-2066
Short Stature in Children: A Review of Literature
Zainab Ahmad Mohammad Jafari
Address: Jazan -Saudi Arabia ,Affiliation: Jazan University, Email: Zainabahmad992@hotmail.com,
Phone number: 0544799357
ABSTRACT
Longitudinal growth assessment is essential in child care. Short stature can be promptly recognized only with
accurate measurements of growth and critical analysis of growth data. Short stature may be normal. Obtaining
the family history of growth patterns and direct measurement of the parents is crucial to determine the genetic
potential for growth in the child. Short stature can also be the sign of a wide variety of pathologic conditions or
inherited disorders when it results from GF or premature closure of the epiphysial growth plates. The causes of
short stature can be divided into 3 broad categories: chronic disease (including undernutrition genetic
disorders), familial short stature, and constitutional delay of growth and development. Treatment may be
medical or surgical; both of them depend on the cause of short stature.
Keywords: short stature, children, genetic disorder.
INTRODUCTION
A- Pathological causes of growth failure
Short stature refers to a height of a human
1- Malnutrition
being which is below typical. Whether a person is
It is a condition that results from eating a
considered short depends on the context. Because
diet in which nutrients are either not enough or are
of the lack of preciseness, there is often
too much such that the diet causes health problems.
disagreement about the degree of shortness that
It may involve calories, protein, carbohydrates,
should be called short . In a medical context, short
vitamins or minerals 3. The symptoms of
stature is typically defined as an adult height that is
micronutrient
deficiencies
depend
on
the
more than two standard deviations below the mean
micronutrient that is lacking. Nutrition plays a
for age and gender, which corresponds to the
fundamental role in determining the growth of
shortest 2.3% of individuals 1.
individuals. An appropriate growth progression is
Growth monitoring in infancy and
considered a harbinger of adequate nutrient intake
childhood has been part of preventive child health
and good health 4.
programs for more than a century, and short stature
On the other hand; growth deceleration
or growth retardation are regarded as relatively
with or without short stature may indicate
early signs of poor health. Growth failure occurs all
inadequate nutrition, even when there is no body
over the world, and there are no indications that
weight deficit for height. Nutritional growth
pathological causes of primary or secondary growth
retardation (NGR) is most prevalent in populations
failure have a different prevalence in different
at risk of poverty. However, in affluent
countries, except for growth failure caused by
communities patients with NGR are often referred
malnutrition which is obviously strongly dependent
to the specialist because of short stature and
on socioeconomic circumstances 2.
delayed sexual development. The diagnosis may be
Despite the similarity of the clinical
overlooked and/or be established after exhaustive
presentation of growth failure in different parts of
evaluations, if the pattern of weight progression
the world, there is a substantial variation in the
over time is not considered 5.
national guidelines for the diagnostic approach to
Patients with so-called idiopathic short
short stature 1. Although at a consensus meeting on
stature may present diminished nutrient intake and
idiopathic short stature (ISS), a list was proposed,
decreased IGF-I levels, however their nutritional
there was little scientific basis for it 2.
status and body weight progression patterns are
usually not addressed by pediatric endocrinologists.
Causes of short stature
NGR patients may cease to gain appropriate weight
Shortness in children and young adults
and fail to grow in height, even without exhibiting
nearly always results from below-average growth in
body weight deficits for height. They adapt to
childhood 3. The causes of short stature can be
decreased nutrient intake by decreasing growth
divided into 3 broad categories: chronic disease
progression and thereby achieve equilibrium by
(including undernutrition, genetic disorders),
decreasing the nutrient demands 6.
familial short stature, and constitutional delay of
This occurs by diminishing their metabolic
growth and development 4.
rates and erythrocyte Na+, K+- ATPase activity;
however they may not present alterations in other
clinical biochemical markers of malnutrition.
2058
Received: 20/12/2017 DOI: 10.12816/0045029
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2067-2071
Glycogen Storage Disease in Pediatric Population
Yara Mofarih Assiri1, Marium Mohammed Iqbal2, Reem Ali Almanie1, Atheer Eed Alotaibi1, Faris
Abdullah S Alharbi3, Bayan Sultan Al Jobran1, Huda F. Abbag1, Mohammed Younes Almoghrabi2, Fahad
Abdulaziz Jarad1, Ashwaq Y. Asiri 1, Mohammad Abdullah Alotaibi4, Wejdan Hamed Alshammari5, Hadil
Mohammed Alenezi6, Badoor Abdrabalameer Alghafli7, Saad Mahmoud Tobaigi2, Amro Sulaiman
AlJuhani8, Maram Mohammed Bajoaifur9, Emtenan Al Ansari9
1 King Khalid University, 2 Batterjee Medical College, 3 University Of Gezira, 4 Imam Muhammad Bin Saud
Islamic University, 5 Hail University, 6 Northern Border University, 7 Arabian Gulf University, 8 King Abdulaziz
University, 9 Ibn Sina National College
Corresponding Author: Yara Mofarih Assiri - Yara.Mm.Aa@Gmail.Com - +966 54 492 8313
ABSTRACT
Introduction: The pathway of glycogen metabolism is regulated by many hormones such as insulin, glucagon, and
corticosteroids. Glycogen storage diseases (GSD) most commonly affect muscles, liver, or both and occur in each
20000 to 43000 live birth. They are classified into 12 subtypes, but types I, II, and IX are the most common.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE,
from January 2001, through February 2017. The following search terms were used: glycogen storage diseases, Von
Gierke disease, Pompe's disease, Cori Disease, Forbes disease, Andersen's disease, McArdle disease, neonatal
hypoglycemia, neonatal hepatomegaly.
Aim: In this review, we aim to study the genetic basis, diagnosis, presentation, and different management approach
to various common types of glycogen storage diseases prevalent in pediatric population.
Conclusion: There are no cures for any type of glycogen storage diseases presently. Most treatments are designed
to control signs and symptoms. The overall goals are primarily avoiding hypoglycemia, hyperlactatemia,
hyperuricemia, and hyperlipidemia. Liver transplantation should be deliberated for patients with GSD type IV and
for other progressive hepatic types of GSDs in order to avoid hepatic failure or malignancy. More research must be
carried out to develop newer and more effective ways of management.
Keywords: neonatal hypoglycemia, glycogen storage diseases, Von Gierke disease, Pompe's disease, Cori
Disease, Forbes disease, Andersen's disease, McArdle disease
INTRODUCTION
Inherited diseases that involve the glycogen
constitute about 80% of cases of GSD with liver
metabolism pathway are called glycogen storage
involvement [1].
diseases (GSD). This pathway of glycogen
metabolism is regulated by many hormones including
METHODOLOGY
insulin, glucagon, and corticosteroids. GSDs most
· Data Sources and Search terms
likely affect muscles, the liver, or both. A GSD can
We conducted this review using a comprehensive
occur in each 20000 to 43000 live births. GSDs are
search of MEDLINE, PubMed, and EMBASE,
classified according to the enzyme defect, and there
January 2001, through February 2017. The following
are about twelve subtypes. For example, type Ia can
search terms were used: glycogen storage diseases,
affect the liver, kidney, and/or intestines. Type Ib
Von Gierke disease, Pompe's disease, Cori Disease,
affects the same organs like type Ia, with addition to
Forbes disease, Andersen's disease, McArdle disease,
leukocytes. Both type Ia, and Ib present classically
neonatal hypoglycemia, neonatal hepatomegaly The
with failure to thrive, hypoglycemia, hepatomegaly,
study was done after approval of ethical board of
hyperlactatemia, hyperuricemia, and hyperlipidemia.
King Khalid university.
Another example is type III, where type IIIa affects
liver and muscles, and type IIIb affects only the liver.
· Data Extraction
As patients age, liver symptoms improve gradually.
Two reviewers have independently reviewed the
Type IV is typically diagnosed in infants, and
studies, abstracted data, and disagreements were
presents with failure to thrive and hepatomegaly, that
resolved by consensus. Studies were evaluated for
gradually progresses to cirrhosis. Type I, III, and IX
quality and a review protocol was followed
throughout.
2067
Received: 20/12/2017 DOI: 10.12816/0045030
Accepted: 30/12/2017
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The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2072-2074
Optic Nerve Glioma- Case Report
Fatimah Al Ghazal, Ebtihal Al Hulaimi, Hassan Al Abbad, Mohammad Al Maani
College of Medicine, King Faisal University, Saudi Arabia
Corresponding author: Fatimah Al Ghazal, Email: dr.f.alghazal@gmail.com
ABSTRACT
Background: Optic nerve gliomas (ONGs) are benign tumors that grow slowly.
Clinical Methods: They are most common in females and occur before age of 20 years. This case report of 10
years girl showed right eye loss of vision and proptosis for 2 months with no other medical problem or past
medical history. Clinical Findings: A diagnosis of ONG was done using CT scan. The CT scan reported right
sided fusiform intra orbital enlargement.
Conclusion: Referral to neurosurgery for consultation and further management was done.
INTRODUCTION
Optic nerve consists of about 1.2 million axons
Surgery is not always an option unless the tumor
that are responsible of vision (1). Optic nerve gliomas
can be completely removed. Radiation therapy can
(ONGs) (also known as optic gliomas) are the most
be used before and after surgery (9). After treatment
common tumors of the optic nerve. They involve the
of ONGs Long-term side effects may occur, such as:
optic nerve or the optic chiasma and are usually
learning disabilities, cognitive difficulties and
polycystic tumors. Up to 30% of ONGs are
impairments in growth (10).
associated with type 1 neurofibromatosis (NF1) (2).
ONGs are rare slow growing benign (noncancerous)
CASE REPORT
tumors. They are usually unilateral and occur most
We reported an interesting case of 10 years old
commonly in females (3). In spite of the fact that
girl child presented with painless outward protruding
these tumors can occur at any age, they are most
of the right eye combined with loss of vision in right
commonly occurred in the childhood (before age of
eye for 2 months with no other medical problems.
20 years), with a median age of 6.5 years and a mean
The girl submitted to detailed and comprehensive
age of 10.9 years (4, 5). Symptoms and signs of the
ocular examination. Visual acuity (VA) was
ONGs include: proptosis (often combined with
measured first, where visual acuity in right eye is
infradisplacement of the globe), decrease visual
counting finger (near face), while the best-corrected
function, strabismus and optic disc swelling or
visual acuity in left eye was 6/6.
pallor. No ocular to retinal pain complains in typical
Detailed anterior segment examination using slit
presentation ONGs. Some patients with ONGs may
lamp and torch light was done. The left eye was
experience central retinal vein occlusion (CRVO),
within normal limit. The right eye showed proptosis,
optociliary shunt vessels, rubeosis iridis with
pupil dilatation with positive relative afferent
neovascular glaucoma and venous stasis retinopathy
pupillary defect (RAPD)(Figure 1). Extra ocular
due to chronic compression of the central retinal
muscle function (EOM) examination in the right eye
vein. In addition, acute loss of vision and
showed 50% deficit of the right superior rectus
development or worsening of proptosis may occur.
muscle and 25% deficit of the right lateral rectus
Some ONGs are asymptomatic (6, 7).
muscle. EOM of the left eye was full. No other
Neurological examination may reveal partial or
positive signs.
total loss of vision. There may also increase pressure
Posterior fundus examination of right eye
in the brain. Computed tomography (CT) scans,
showed generalized optic disc pallor with partial
magnetic resonance imaging (MRI) of the brain, and
optic atrophy. Venous tortuosity was also seen
biopsies are used as a diagnostic studied in ONGs (8).
(Figure 2). With no other retinal signs. The left eye
The aim of all treatment strategies is to reserve
was within normal limit. Intraocular pressure (I.O.P)
vision for as long as possible. Both surgery and
was 18 mm in the right eye and 16 mm in the left
radiations are two possible ways to treat ONGs.
eye.
2072
Received: 20/12/2017 DOI: 10.12816/0045031
Accepted: 30/12/2017
c:\work\Jor\vol7012_8
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2075-2076
Case Report: Pituitary Macroadenoma with Calcification
Qusai Radi Alfehid, Mahmmoud Taha
Department of neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
Corresponding Author E-mail: qrmz2007@gmail.com
ABSTRACT
Background: sellar-suprasellar tumor calcification mostly is craniopharyngioma but rarely can be found in
Pituitary Adenomas.
Aim of the work: This article aim to describe a case report of Pituitary Macroadenoma with calcifications.
Results: Clinical and radiological management were discussed.
Conclusion: The case demonstrated the possibility of uncommon presentation of pituitary adenoma.
Keywords: Calcification, pituitary Adenomas, craniopharyngioma.
INTRODUCTION
CASE REPORT
Sellar suprasellar lesion with calcification mostly
58 years old male, married, not a smoker known
is craniopharyngioma [1].However, in some cases
case of diabetes mellitus, hypercholesrolemia and
calcification can occur rarely in cases of pituitary
pituitary adenoma which diagnosed at age of 48
adenomas and Rathke's cleft cysts [2,3]. Differential
years old when he had deterioration of the vision
diagnosis preoperatively is important, and the
mostly in the left eye, weight gain, impotence,
presence or the absence and type of calcification
erectile dysfunction.
module can be helpful for distinction between these
On 2/11/2016, the patient was presented to ED
rare pathologies [3]. The authors describe a case of
complaining of deterioration of vision, weight gain,
calcified sellar suprasellar lesion, which was finally
impotence
and
erectile
dysfunction.
On
diagnosed as a pituitary macroadenoma .The case
examination the patient was conscious, alert,
highlights this imaging feature as it is important to
oriented, pupils bilateral reactive 3mm, right visual
differentiate between craniopharyngioma and
field intact and left eye temporal hemianopia, other
pituitary adenoma in the therapeutic and prognostic
cranial nerves were intact, no sensory or motor
point of view. It is considering the varied and more
deficit. Imaging shows (a calcified sellar suprasellar
aggressive behavior of craniopharyngiomas as
mass) . The patient admitted for surgery.
compared to pituitary adenomas.
Figure (1): CT of the brain sagittal and axial views, which show sellar suprasellar lesion with calcification
2075
Received: 20/12/2017 DOI: 10.12816/0045032
Accepted: 30/12/2017
c:\work\Jor\vol7012_9
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2077-2080
Pharmacogenetics of Proton Pump Inhibitors: Short Review
Madkoor Mujeeb Alrhman Idaros A 1, Harshan Fahad Mohammed 2, Harisi Abdulrahman
Hassan3, Noshily Mohammed Abdullah A 4, Alrayani Abdullah Abdu 5, Sarhan Yasir Eisi 6,
Halawi Hatim Ali A 1, Shammakhi Ibrahim Nasser M 7, Ayyashi Mohammed Ali Hussain 8
1. King Fahad Central Hospital, 2. King Abdulaziz Special Hospital,
3.Al Hada Armed Forces Hospital, 4. Haql General Hospital, 5. Abbott Laboratories,
6.Sandoz Company, 7. Jazan Unversity Hospital, 8. Armed Forces Hospital Jazan
ABSTRACT
Background: Proton pump inhibitors are substituted benzimidazoles compounds, they are used as agents for
the treatment of acid-peptic diseases. These compounds are metabolized by several enzymes, the genetic
variations in these enzymes were thought to influence the pharmacogenetics of the proton pump inhibitors
and in turn influence the outcome of the patients.
Aim: To highlight the pharmaco-genetics of proton pump inhibitors
Methods: Scientific websites were used to search for articles such as Pubmed and Google Scholar. Several
keywords were used to obtain all possible articles concerned with the subject.
Results: We reviewed 6 articles about the current subject, there were few articles about the pharmacology of
proton pump inhibitors.
Conclusion: Few studies have focused on the pharmacogenetics of proton pump inhibitors and most of them
were trials, also there were no previous review articles studied this subject.
Keywords: PPI, Peptic ulcers, Genetic variations, Pharmacogenetics.
INTRODUCTION
Proton pump inhibitors (PPIs) are agents that
they didn't involve the main points we searched for,
considered as a major advance in the treatment of
while 6 articles were reviewed. These 6 articles were
acid-peptic diseases. They are the most common
published between 2002-2017.
class of medication prescribed in the primary care
The study was done after approval of ethical
setting [1]. These agents ranked in the top of 10
board of King Fahad Central Hospital.
national health-related drug expenditures in US in
2015 [2]. The introduction of first PPI which was
1.Pharmacology of Proton Pump Inhibitors
omeprazole (Prilosec), was in 1989, after that
(PPI):
several PPIs became available [1] including
PPIs are substituted benzimidazoles compounds
rabeprazole, pantoprazole and lansoprazole [3]. PPIs
which are administrated either as capsules or enteric-
are selectively and irreversibly inhibit the gastric
coated tablets which pass through the stomach
hydrogen potassium adenosine triphosphatase
reaching to proximal small bowel where they are
(H+K+- ATPase) pump mechanism in gastric
absorbed [1]. After absorption, PPIs have short
parietal cells [3,4]. PPIs are used for the treatment of
plasma half-life which ranges from one to 2 hours,
Barrett's esophagus, Zollinger-Ellison Syndrome,
while duration of action is much longer as they have
gastroesophageal reflux disease and peptic ulcer
a unique mechanism of action [1].
disease [3]. The pharmacological effects of most
As PPIs are lipophilic weak bases, they cross the
drugs are dependent on both the pharmacokinetic
parietal cell membrane and then enter the acidic
process and pharmacodynamics [5]. These processes
parietal cell canaliculus. PPIs becomes protonated in
in turn occur at variable levels in each individual,
the acidic environment, this results in producing the
and the major determinant of this variability is
activated sulphenamide form of the drug which has
genetics [5]. In the present review we highlighted the
the ability to bind covalently with the H+/K+
pharmacogenetics of PPIs as well as uses of PPIs.
ATPase enzyme, this in turn results in irreversible
inhibition of acid secretion by the proton pump [6-8].
MATERIALS AND METHODS
Rabeprazole (Aciphex) differs from other PPI,
In the current review, we used the internet to get
where it forms a partially reversible bond with the
the articles related to our subject, we used several
proton pump, it is also activated at a broader range
key words including PPI, PPI metabolism,
of gastric pH, so it has more effect on acid-
Pharmacogenetics of PPI, PPI uses. Scientific web
suppressing than the other PPIs [6,7,9].
sites were used for researching for articles such as
For resuming acid secretion, the parietal cell must
Pubmed, Google Scholar and research Gate. We
activate resting pumps or produce new proton pumps
obtained 17 articles, 11 of them were excluded as
[6,7].
2077
Received: 20/12/2017 DOI: 10.12816/0045033
Accepted: 30/12/2017
c:\work\Jor\vol7012_10
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2081-2089
Effectiveness of Cognitive Therapy in Treatment of
Borderline Personality Disorders
Faris Ali Nasser Ayidh (1), Abdullah Ali Abdullah Alhassani (2), Adil Ali Ayed (3),
Ali Hadi Hadadi (4), Hossien Moteq Moshabab Alqahtani (5), Hiba Salah Abdelgadir(6)
1-King Khalid University, 2-King Khalid University 3- Family Medicine, King Khalid University,
4- Psychiatric resident, 5- Psychiatric resident, 6 - Family Medicine, UMST University
Corresponding author: Faris Ali Nasser Ayidh, Email: dr.research222@gmail.com
ABSTRACT
Background: treatment of borderline personality disorders include in addition to medications several
evidence-based psychotherapy treatment models, including schema focused therapy, dialectical behavior
therapy, transference focused psychotherapy and cognitive behavioral therapy.
Objective: this study aimed to evaluate all randomized controls trials of pharmacological interventions in
comparison with psycho educational group interventions in the treatment of borderline personality disorders.
Methods and Materials: this was an electronic search and it was conducted by using search strategy of
cognitive psychotherapy and borderline personality disorder in MEDLINE, EMBASE and PsycINFO
databases. Trials included in this review were clinical trials with cognitive interventions for subjects meeting
DSM or ICD criteria for personality disorder.
Results: the search of the literature, after exclusion of irrelevant, duplicated and review studies, revealed 24
randomized controls trials that met the inclusion criteria. Included studies aimed to assess the effectiveness of
a cognitive behavior therapy in treatment of border line personality disorders.
Conclusions: we concluded that the use of cognitive therapy is important in treatment of borderline
personality disorder in addition to pharmacological treatment and treatment as usual. Doctors must choose the
most effective type of cognitive therapy according to their patients' diagnosis, duration of the treatment and
the available resources.
Keywords: personality, disorders, cognitive, interventions, effectiveness
INTRODUCTION
Borderline personality disorder (BPD) is a
behavior therapy (DBT) was found to be useful in
mental health disorder manifest by a universal
treating many symptoms of the BPD (7).
pattern of instability in interpersonal relationships,
Moreover, Linehan et al. has developed a
self-image, affect, behavior, extreme emotions and
cognitive behavioral intervention, dialectical
impulsiveness (1). BPD is characterized by
behavior therapy (DBT) (8), for borderline
numerous dangerous behaviors, a feeling of
personality disorder. The dialectical behavior
barrenness, self-harm, and a great fear of rejection.
therapy is an effective treatment that have its own
The behavior usually begins in early adulthood,
target and categorized order of importance. DBT
and occurs across a variety of situations.
emphases on decreasing life threatening and
Substance abuse, depression, and eating disorders
suicidal performances, including para suicide
are commonly associated with BPD. BPD
incidents (9), actions that associated with treatment,
increases the risk of self-harm and 10% of those
mainly noncompliance and premature dropout,
people attempt suicide (2).
factors that strongly affect the quality of life,
Psychotherapy has been actively followed and
including
those
which
demand
inpatient
included in many researches. Treatment of BPD
psychiatric care and increasing general coping
included in addition to medications several
skills (10).
evidence based psychotherapy treatment models,
This study aimed to evaluate all randomized
including schema focused therapy, dialectical
controls trials of pharmacological interventions in
behavior therapy (3, 4), transference focused
comparison with psycho educational group
psychotherapy and cognitive behavioral therapy (5,
intervention for participants meeting DSM or ICD
6).
criteria for personality disorder to assess the
The effectiveness of cognitive behavioral
effectiveness of a cognitive behavior therapy.
therapy (CBT) in treatment of borderline
personality disorder (BPD) has been studied in
METHODS
many randomized controlled trials. From the time
An Electronic search was conducted using
when a landmark controlled trial (3), dialectical
search strategy of (Cognitive psychotherapy) And
2081
Received: 20/12/2017 DOI: 10.12816/0045034
Accepted: 30/12/2017
c:\work\Jor\vol7012_11
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2090-2199
A Comparative Study between Ultrasound Guided Quadratus
Lumborum Block Versus Ultrasound Guided Transversus
Abdominis Plane Block in Laporoscopic Bariatric Surgery
Azza M. Shafeek, Gihan A. Gomaa, Fady A. Abd ElMalek,
Khaled M. Hassan, Doaa W. Muhammad*
Department of Anesthesiology, Ain Shams University
*Corresponding author: Doaa W. Muhammad, email: drdoaawagdy@gmail.com
ABSTRACT
Background: ultrasound-guided quadratus Lumborumblock is performed as one of the perioperative pain
management procedures for patients undergoing abdominal surgeries.
Objective: the aim of this study was to compare the analgesic efficacy of ultrasound-guided trans-muscular
quadratus lumborum block with transversus abdominis plane (TAP) block and intravenous opioid drugs
during laparoscopic bariatric surgery and in the early postoperative period regarding pain relief, provision of
comfort, early mobilization and improved respiratory functions.
Patients and Methods: Setting and design: pilot exploratory study was conducted on 60 patients scheduled
for elective laparoscopic bariatric surgeries. All patients received general anesthesia using IV fentanyl (1-2
g/kg LBW). Group QLB (20 patients): received bilateral ultrasound-guided quadratus lumborum block
after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%. Group TAP (20 patients):
received bilateral ultrasound-guided TAP block after induction of general anesthesia using 0.2 ml/kg
bupivacaine 0.125%. Group GA (20 patients): received general anesthesia and then IV Morphine (0.1
mg/Kg LBW).
Results: there was statistically significant difference between the three groups as regardsthe first call for
rescue analgesia (morphine), total morphine consumption and pain scores; indicating that tansversus
abdominis plane block was more effective than intravenous opioid drug analgesia, while quadratus
lumborum block was more effective than tansversus abdominis plane block.
Conclusion: this study concluded that quadratus lumborum block was the most effective technique in
providing analgesia after laparoscopic bariatric surgery without associated hemodynamic instability in
comparison to transversus abdominis plane block and intravenous opioid drugs.
Keywords: QLB, TAP, Morphine, Bariatric, Obesity.
INTRODUCTION
sedation and respiratory compromise. The
Obesity has been associated with an
pathophysiology of obesity, typical co-morbidities
increased hazard ratio for all-cause mortality, as
and the high prevalence of obstructive sleep apnea
well as significant medical and psychological co-
(OSA) amongst obese patients make safe
morbidity.
Nonsurgical
management
can
analgesic management difficult. In particular, pain
effectively induce 5%-10% weight loss and
control after bariatric surgery is a major
improve health in severely obese individuals
challenge. Advice on general management
resulting in cardio-metabolic benefit. Bariatric
includes multimodal analgesic therapy, preference
surgery procedures are indicated for patients with
for regional techniques, avoidance of sedatives,
clinically severe obesity. Currently, these
non-invasive ventilation with supplemental
procedures are the most successful and durable
oxygen and early mobilization (2).
treatment for obesity. The best choice for any
In the past few years, transversus
bariatric procedure (type of procedure and type of
abdominis plane (TAP) block, which was first
approach) depends on the individualized goals of
described by Rafiin (3) in 2001, has been
therapy, available local expertise, patient
increasingly used for postoperative pain relief
preferences and personalized risk stratification. In
after laparoscopic surgery. As a part of
general, laparoscopic bariatric procedures are
multimodal analgesic regimen, TAP block results
preferred over open bariatric procedures due to
in less analgesic consumption and less pain at two
lower early postoperative morbidity and mortality
hours and slightly at six hours after laparoscopic
(1).
surgery in comparison with the usual opioids
In the obese patient, the goal of
alone.
postoperative pain management is provision of
The quadratus lumborum block (QLB)
comfort, early mobilization and improved
was first described by Blanco in 2007. The main
respiratory function without causing inadequate
advantage of QLB compared to the transversus
2090
Received: 20/12/2017 DOI: 10.12816/0045035
Accepted: 30/12/2017
c:\work\Jor\vol7012_12
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2100-2109
Public Awareness of Vitamin " D " Deficiency among
Children in Najran City and The Role of
Primary Health Care Centers in Raising Their Awareness
Amani Mohammad Abbad Alwadei*, Norah Saad M Al-Johani, Soha Saleh Mohammed AlZamanan,
Alanood Mohammad Abbad Alwadei, Mervat Hassanein
Family and Community Medicine Department, College of Medicine, Najran University, Ministry of
Education, Kingdom of Saudi Arabia
*Corresponding author: Amani Mohammad Abbad
Alwadei,Telephone:+966506616890,email:Amani_Alwadei@yahoo.com
ABSTRACT
Background: Vitamin D is one of fat-soluble vitamins. It has of great importance in increasing intestinal
absorption of calcium, magnesium, phosphate, and zinc. Sun is the main source for this vitamin and there
are few foods that contain it, for example milk and egg. From a long standing, vitamin D deficiency has
been a health problem in the world. Vitamin D has great importance in the growth of bone, so the
deficiency of it or imbalance of its metabolism inside the body leads to major problems, most notably of
them is rickets among children. Objectives: This is a cross-sectional study, aiming to study the awareness
of public regarding vitamin D deficiency among children and to reveal the role of primary health care in
raising people's awareness of vitamin D deficiency.
Materials and methods: Electronic questionnaires are used to collect data. They contain personal socio-
demographic characteristics, information about vitamin D deficiency and the role of primary health care in
raising people's awareness of vitamin D deficiency. The study recruits 500 participants; medical field
workers were not included in the study. Data were analyzed using SSPS version 22.
Results: It was observed that 89% of the total sample size has knowledge on vitamin D where 94.3% of
mothers heard about vitamin D, 68% knew that vitamin D is important, and 72.11% believed that vitamin D
is manufactured in the body. More than two thirds (69.83%) said that the ultraviolet sun-rays is the main
source of vitamin D and 68.88% of parents declared that they had attend a lecture given by a physician in in
the primary health care center on the importance of vitamin D where, fathers (40.2%) were more than
mothers (26.6%) in getting their information.
Conclusion: More research is needed to assess the level of community awareness as it is the best solution
to reduce or eliminate the problem. Health education campaigns about vitamin D and its importance with
more intensification in Men places as they had a low awareness. Training of primary health care physicians
and their supervision for raising awareness of their community.
Keywords: Vitamin D, Deficiency, Awareness, Rickets.
INTRODUCTION
the mid-17th century in London, England 3. The
Definition
problem of the situation described was skeletal
Vitamin D is one of fat-soluble vitamins. It
deformities. Vitamin D has great importance in
has of great importance in increasing intestinal
the growth of bone, so the deficiency of it or
absorption of calcium, magnesium, phosphate,
imbalance of its metabolism inside the body leads
and zinc. Sun is the main source for this vitamin
to major problems, most notably of them is
and there are few foods that contain it, for
rickets among children 4.
example milk and egg1. The normal range of
vitamin D is defined as a 25(OH)D.
B) Locally
Concentration greater than 30 ng/mL (75
Researches in Saudi Arabia have studied
nmol/L), insufficiency range from 20 to 30
Osteomalacia and Rickets in different ages and
ng/mL (50 to 75 nmol/L) and deficiency is less
both sexes5, 6. Significantly more women than
than 20 ng/mL (50 nmol/L).2
men suffered from vitamin D deficiency this was
explained by the fact that men are more exposed
Background information (global and local)
to sunlight than women. Although Jeddah city is
A) Global:
From a long standing, Vitamin D deficiency has
sunny most of the year, the rate of vitamin D
been a health problem in the world. The first one
deficiency is increasing 3. So, we want to study
who described the condition of vitamin D
the situation in Najran, which is also sunny most
deficiency is Glisson and his colleagues during
of the year. Studies5, 6 which evaluate awareness
2100
Received: 20/12/2017 DOI: 10.12816/0045036
Accepted: 30/12/2017
c:\work\Jor\vol7012_13
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2110-2115
Attitude towards Seasonal Influenza Vaccination by Healthcare Workers
Norah Abdullah Alqartun
Almaarefa Colleges for Science & Technology, Riyadh, Saudi Arabia.
ABSTRACT
Background: Influenza is an airborne communicable disease; it is effectively can be prevented by vaccination.
Healthcare workers (HCWs) contact with different patients with different diseases and different immunity levels,
vaccination of healthcare workers for influenza can protect both healthcare workers and their patients. Although
the vaccine is available and proved to be safe, there is low rate in uptake of vaccination. Aim: To estimate the
influenza vaccination rate among HCWs and determine the role of different factors on acceptance of influenza
vaccine. Methods: This cross-sectional study was conducted on all healthcare workers at Al-Wazarat health care
center, PSMMC, Riyadh, Saudi Arabia. A well-established questionnaire was used in this study to obtain required
data including demographics and vaccination state of participants and their beliefs about the vaccination.
Results: There were 50.5% of HCWs have received influenza vaccination for 2016-2017 season. Several factors
were associated with vaccination state including age (P-value=0.04), nationality (P-value=0.01) and having
chronic disease (P-value=0.004). The mean score for HCWs`attitude was 37.6±5.67, and it significantly increased
in vaccinated (39.15±5.23) than non-vaccinated participants (36.19±5.7). Nature of work and nationality
significantly affected the mean score (P-value=0.02, 0.01) respectively. Conclusion: Vaccination uptake rate was
low among health care workers with moderate acceptance rate for vaccination, vaccinated persons had higher
acceptance score than non-vaccinated one.
Keywords: Influenza vaccination, HCWS vaccination acceptance, HCWs Vaccination in KSA.
INTRODUCTION
the uptake of vaccination by HCWs is low in rate in
Influenza is the most common airborne infection
many countries [15,16]. It was found that in US, 36%
[1] and a highly contagious-vaccine preventable-
of HCWs received influenza vaccination [17], however
infectious disease [2]. It was evaluated that the
other studies [18,19] reported rates of immunization
influenza affected almost 9% of population in the
among doctors ranged from 38% to 82%. It was
world annually and accounts for annual 1 billion
stated in one study that in Saudi Arabia the overall
infections and 3-5 million severe cases and deaths [3].
rate of influenza vaccination was low [20]. In the
Influenza symptoms range from mild to severe
present study we aimed to assess the acceptance of
reaching to death [1]. Healthcare workers (HCWs) are
influenza vaccination among HCWs.
more prone to transmit communicable diseases as
they work in hospitals dealing with different patients
SUBJECTS AND METHODS
with different diseases [4]. Influenza virus can be
Subjects and study design
transmitted from persons infected with influenza
This study is cross sectional study that included all
virus, even those with subclinical infections to
healthcare workers at Al-Wazarat health care center,
individuals who are at higher risk of complications
PSMMC, Riyadh, Saudi Arabia. It was conducted in
from influenza such as immune-compromised and
the period from October 2017 to November 2017. A
elder patients [5]. Healthcare facilities are perfect
well-structured questionnaire was used to get the
places for the rapid spread of influenza, it was
relevant data needed in our study. The first part of the
identified that HCWs were the primary vectors for
questionnaire included introduction and instructions.
spreading influenza virus within these facilities [6,7].
The second part was about socio-demographics and
The risk of infection and influenza-like-illness for
included age, gender, marital status, nationality and
HCWs can be reduced by influenza vaccination [8]. occupation. The third part was carefully designated to
In HCWs, the vaccination is the important preventive
ask about the acceptance of influenza vaccine among
strategy against influenza [9]. Influenza vaccine can
HCWs and factors that influence it. An ethical
prevent influenza in healthy adults whose age less
approval for this study was obtained from ethics
than 65 years old by a rate of 70-90%[10,11], while in
review committee in King Saud Medical City. The
those with age of 65 years, vaccination reduces the
confidentiality of the anonymous collected data was
risk for influenza-related hospitalization and death
maintained all the time. All data were stored in a
and it prevents secondary complications [12]. Both
secure and safe place which was only accessible by
WHO and Centers for Disease Control and
the researcher. Informed consent was distributed with
Prevention (CDC) recommend influenza vaccination
the questionnaire to all participants.
for HCWs [13] as well as United States Advisory
The study was done after approval of ethical
Committee on Immunization Practices (ACIP) [14].
board of Almaarefa Colleges for Science.
Although vaccination is available, it was found that
Statistical analysis
2110
Received: 20/12/2017 DOI: 10.12816/0045037
Accepted: 30/12/2017
c:\work\Jor\vol7012_14
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2116-2120
General View of Optometrists' Acceptance of the
Orthokeratology Concept in Jeddah, KSA
Darwish Tariq Khizindar, Rabaa Hashim Alhibshi,
Ahmed Abdulrahman Basheikh, Hiba Hani Kashif
King Abdulaziz University Hospital, Jeddah, KSA
Corresponding author: Darwish Tariq, Khizindar, email:Darwish.khizindar@gmail.com, mobile:+966595135679
ABSTRACT
Introduction: Orthokeratology refers to the creation of gas permeable contact lenses that temporarily reshape
the cornea to reduce refractive errors such as myopia, hyperopia, and astigmatism without the need for any
surgical intervention. Despite these advantages and the fact, it has gained its FDA approval, its still a matter
of controversy and its viability as a long-term treatment is yet to be discovered.
Aim: To view and investigate the prevalence of optometrists acceptance of the orthokeratology concept.
Methods: A cross-sectional study was conducted from the attendees at the "Red Sea Ophthalmology
Symposium" Jeddah, western region, kingdom of Saudi Arabia during the period of 10-13 January 2018.
Statistical analysis was performed using the SPSS software package.
Results: A total of 57 randomly selected optometrists, the majority of which were Saudi (80.7%) and worked
at governmental facilities (73.7%). (56.1%) did not have background of Orthokeratology. (45.61%) of whom
have acquired previous knowledge on the matter, might consider prescribing of the lenses justified their
choice based on its effectiveness in the treatment of myopia without any surgical interventions (23.8%).
While those who chose to disapprove of its viability as treatment despite their previous knowledge on the
subject justified their choice based on the possible complications that could arise from its long-term use
(9.5%), their incomplete understanding of the full concept of orthokeratology lenses appliance (42.9%), and
based on previous studies that was not encouraging to them to consider prescribing it (21.4%).
Conclusion: This study concluded that optometrists in general had limited knowledge on the matter, which
had led them not to consider prescribing it because it is a matter of controversy due to the limited amount of
studies needed to approve it as a more beneficial alternative to surgical intervention than disadvantageous on
the long term. Also being a temporary solution hasnt been an impelling factor to the doctors when it comes to
prescribing it for the sake of their patients safety for the time being.
Keywords: Optometrists, Orthokeratology, Knowledge, Opinion.
INTRODUCTION
Orthokeratology (also referred to as Ortho-
type of orthokeratology design lens was the
K, Overnight
Vision
Correction, Corneal
"Contex OK-Lens". Later on, in June 2002 the
Refractive Therapy, and CRT), refers to the
FDA granted approval for overnight wear to a type
creation of gas permeable contact lenses that
of corneal reshaping lens called "Corneal
temporarily reshape the cornea to reduce refractive
Refractive Therapy" (CRT). Although, every
errors
such
as myopia, hyperopia,
intervention has its benefits and disadvantages, the
and astigmatism, without the need for any surgical
patients overall have come to accept using it and
intervention. During the 1960s, George
fortunately met satisfactory results (1). There have
Jessen created what was probably the first
been well documented positive effects in slowing
orthokeratology
lens
design
made
down axial length in anisometric patients
from PMMA material, which he marketed as
bilaterally (2) and the progression of myopia and
"Orthofocus". These early designs had generally
refractive error in both pediatric and adult ages (3, 4)
unpredictable results, leading to the belief which
which gives it some advantages over other medical
implied that orthokeratology was more art or luck
or surgical interferences. However, other studies
than science. However, not many years later this
concluded that overnight orthokeratology has a
idea has grown to be viable enough to gain its first
temporary effect, increases corneal irregularity and
FDA approval in 1994 through experimental
ocular higher-order aberrations (especially in
improvements. The first FDA daily wear approved
spherical aberration for a correction of myopia) (4)
2116
Received: 20/12/2017 DOI: 10.12816/0045038
Accepted: 30/12/2017
c:\work\Jor\vol7012_15
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2121-2126
Knowledge and Beliefs of Immunization during Pregnancy
among Reproductive Age Women in Saudi Arabia
Zainab Mohammed Al Eid*1, Mohammed AlMatar1, Jihad AlGadeeb2, Rabel Khawaja1
(1) Family medicine department, King Faisal University, (2) Primary health care center, Hufof, KSA.
*Corresponding author: Zainab Mohammed Al Eid, Email: aleidzainab@gmail.com , Telephone: 0966567025838
ABSTRACT
Background: Various infectious diseases affect pregnant women causing serious complications which are
preventable through vaccines that serve as a protection tool for both mother and fetus during pregnancy and
further after delivery. Objectives: This study aims to explore the level of awareness about infectious diseases and
importance of immunization, safety, and beliefs among reproductive age women in Saudi Arabia to identify the
needs for initiating educational programs.
Methods and materials: A cross-sectional survey conducted between November 2016- January 2017 amongst
reproductive age between 18-35 years old females from Al Ahsa, Eastern province in Kingdom of Saudi Arabia.
Results: A total of 783 females enrolled in the survey. One-third (31%) believed it is best to avoid immunizations
during pregnancy. About flu vaccine, 40.2% of females deny that flu vaccination is strongly recommended for
pregnant women during the flu season and 40.4% do not know about it. Most females (61.7%) have not heard or
attended any activities about vaccination during pregnancy, but 59% are willing to attend any activity conduct
regardless this issue. Conclusions: Overall, vaccine-related knowledge is poor among young adult females in
Saudi Arabia. Therefore, prompt actions such planning for strategic initiatives and preparing an educational
material is recommended to tackle this issue.
Keywords: Immunization, vaccine, Pregnancy, influenza, knowledge, beliefs.
INTRODUCTION
Various infectious diseases affect pregnant women
Therefore, the US Advisory Committee on
cause serious complications which are preventable
Immunization Practices of the Centers for Disease
through vaccines that serves as a protection tool for
Control (CDC) and World Health Organization
both mother and fetus during pregnancy and further
(WHO) identified pregnant women as the highest
after delivery. Since past few decades, evidence of
priority group and advises pregnant women for
consequences followed by infections is higher among
prevention through receiving specific vaccine such
pregnant women as it equivalently increased rates of
influenza during flu season. Furthermore, there are
admission and hospitalization as four times higher
additional specific vaccines recommended to uptake
comparing to those whom are non-pregnant [1].
preconceptionally or postpartum such as MMR and
Furthermore, not only mothers but also their children
varicella. Correspondingly, further vaccines must
whom are of age less than 6 months are also having
uptake with special circumstances in case the pregnant
higher mortality rate as a result of infections such as
woman at risk of having hepatitis to receive hepatitis B
influenza than general population [2].
vaccines [6]. Although all published studies and
A study conducted by Carlson reported that in
available data strongly support the safety and
2009 H1N1 influenza once pandemic caused higher
effectiveness of influenza vaccination during
hospitalization rate among pregnant women with 7-
pregnancy but the uptake is remaining suboptimal.
fold rate and responsible for 6% of all accounted death
Some studies reported about barriers such as vaccine
comparing to 1% of the general population [3].
safety concerns, mistrust in the vaccine, low risk
A randomized controlled trial conducted in
perception of the disease, and poor vaccine-related
Bangladesh concluded that mothers who are
knowledge [7].
immunized with influenza vaccine in third trimester
Similarly, pertussis infection is also associated
had fewer respiratory complications related to
with increased risk of complication amongst newborns
influenza reduced by 36% compared to the control
comparing to general population [8]. As hospitalization
group [4]. Various observational studies conducted
and mortality rates estimated of pertussis-infected
have demonstrated further findings that newborns of
babies are about Two-thirds occurrence [9], therefore,
mothers
immunized
during
pregnancy
or
US recommended in 2011 of routine administration for
preconceptions against influenza are protected from
pertussis vaccine for pregnant women known as
influenza symptoms [5].
tetanus, diphtheria and acellular pertussis (Tdap)
2121
Received: 20/12/2017 DOI: 10.12816/0045039
Accepted: 30/12/2017
c:\work\Jor\vol7012_16
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2127-2129
Effect of Chronic Hypoxia in Cognition on Childhood: Review Article
Shuruq Mohammed Aljaafari, Assma Khaled Salwy
Jazan University
ABSTRACT
Background: Hypoxia is defined as the reduction of the normal oxygen supply. The hypoxia is traditionally
classified as acute and chronic. Chronic hypoxia was classified into three subgroups: diffusion-limited
hypoxia, hypoxemic hypoxia, and hypoxia due to a compromised perfusion of leaky micro vessels. Serious hypoxic-
ischemic events are known to have an adverse impact on cognitive function. Aim: to review the evidence
concerning the effect of chronic hypoxia on childhood cognitive outcomes including development and academic
achievement.
Materials and Methods: We used scientific websites such as PubMed, Google Scholar, and Research Gate to get
related articles about this subject.
Results: There were 15 articles included in this review including both research and review articles.
Conclusion: It has been suggested that cognitive function including knowledge, attention, memory and Oxygen
supply to the brain tissue may be decreased under hypoxia. Thus, brain desaturation and resultant biological
process may be responsible for the impairment of cognitive function although the underlying mechanisms are still
unclear
Keywords: Chronic Hypoxia, Diffusion-limited hypoxia, Hypoxemic hypoxia.
INTRODUCTION
of chronic hypoxia and management of chronic
The oxygen gas (O2) is a necessary element for
hypoxia" to find
obtaining the life of aerobic organisms. In the
mitochondrial respiratory chain the oxygen is the
final receptor of electrons [1,2]. This allows the
ultimate process of oxidative phosphorylation and the
more articles on the subject. We were more
generation of cellular energy, in the form of
concerned about English published articles only
adenosine triphosphate (ATP). The most metabolic
which published from 1995 to 2017.
pathways requires the ATP molecules as a major
source of energy hence ATP molecules are necessary
Classification of Chronic hypoxia
to maintain cellular viability.
This traditional classification of hypoxia into only
Under normoxial conditions a cell continuously
two subgroups (chronic and acute) is based on
maintains a high and constant ratio of cellular
empirical observations solely and widely discounts
ATP/ADP in order to survive this reflect the
the multiple pathogenetic processes involved [4].
dependence on oxygen. Therefore, a reduction of the
Chronic hypoxia was classified into three
normal oxygen supply (hypoxia) will have
subgroups: diffusion-limited
hypoxia, hypoxemic
consequences on the cell viability [2]. Hypoxia is
hypoxia, and hypoxia due to a compromised perfusion
encountered not only in different conditions including
of leaky microvessels [5]. Diffusion-limited chronic
the patho-physiological
conditions,
such as
hypoxia is very common in solid tumors. In
atherosclerosis, obstructive sleep apnea, mountain
neoplastic tissues increased cell proliferation
sickness, ischemic diseases (stroke) and cancer, but
frequently outpaces angiogenesis, resulting in tumor
also in physiological processes, such as embryonic
cells extending beyond the oxygenation zones that
development [3].
surround blood vessels. This is exacerbated by the
high metabolic demands of tumor cells, and
MATERIALS AND METHODS
unreliable vessel perfusion [6, 7].
We used scientific websites such as PubMed,
Reduced oxygenation elicits activation of
Google Scholar, and Research Gate to get related
Hypoxia-Inducible Factors (HIFs), representing an
articles about this subject. The research process
evolutionarily conserved physiological response
involved specific keywords effect of chronic
which coordinates a range of adaptive changes in
hypoxia on cognition among children, classification
gene expression and cross-communicates with other
signaling pathways [6, 8].
2127
Received: 20/12/2017 DOI: 10.12816/0045041
Accepted: 30/12/2017
c:\work\Jor\vol7012_17
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2130-2136
Prevalence of Impacted Teeth and Associated Pathologies
A Radiographic Study, Al Ahsa, Saudi Arabia Population
Ahmad M. Al-Ramil1, Ali M. Al-Wosaibi1, Mohammed T. Bukhary 1
Mahdi M. Al-wusaybie2.
1 College of Dentistry King Saud University, 2 College of Dentistry
Imam Abdulrahman bin Faisal University
Corresponding author: Ahmad M. Al-Ramil, E-mail: F_uoh@hotmail.com, mobile: 0555156989
ABSTRACT
Background: Impaction has been defined as a tooth which is prevented from completely erupting into a
normal functional position within the expected time, due to lack of space, obstruction by another tooth or an
abnormal eruption path [5], inadequate bony length and insufficient development of the retromolar space with
the tooth either partly visible/in communication with the oral cavity or completely invisible.
Objectives: To investigate the prevalence of impacted teeth and associated pathologies in Al Ahsa, Saudi
population.
Materials and Methods: this is a retrospective study. The total record of 1985 patients were examined
found 537 patients with impacted teeth and 130 patients have panoramic x-ray, digital camera was used with
plastic box on x-ray viewer to stabilize the magnification.
Results: 27.1% of Saudi patients in Al Ahsa presented with at least one impacted tooth. Among the 355
impacted teeth, the mandibular third molars were the most common impacted tooth (62.3%), followed by the
maxillary third molars (30.7%), and the least was the maxillary canine (1.7%). The results of this study
indicated that caries was associated with 23.1% of the impacted third molars and 11.5% of the distal surfaces
of adjacent second molars. The results of this study indicated that pericoronitis was associated with 61.5% of
impacted third molars. Caries was associated with 23.1% of the impacted third molars and 11.5% of the
distal surfaces of adjacent second molars. Root resorption was associated with 3% of the second molars that
was adjacent to the impacted third molars. Dentigerous cyst was associated with one of impacted tooth.
Conclusion: The prevalence of impacted teeth was high, and there was a predominant for impaction of the
mandibular third molars in this study of Al Ahsa Saudi population. Pericoronitis associated with impacted
mandibular third molar were related to the erupted maxillary third molars created potential trauma of the
pericoronal tissues of the partially erupted mandibular third molars. Caries and periodontal disease were
commonly associated with the impacted third molars, whereas root resorption and cystic pathology were
rarely observed.
Keywords: Impacted teeth, Radiographic study, Molar, wisdom teeth.
INTRODUCTION
Teeth may become impacted when they
of the population but impaction rates of up to 40%
fail to erupt or develop into the proper functional
have been noted [6].
location [1]. Impaction has also been defined as a
Incompletely erupted third molar could give
tooth which is prevented from completely erupting
cause for various symptoms and pathologies, such
into a normal functional position within the
as pericoronitis, pain, swelling, cheek ulceration,
expected time, due to lack of space, obstruction by
distal caries, bone loss and root resorption of
another tooth or an abnormal eruption path [2],
adjacent teeth, odontogenic cysts, benign or
inadequate bony length [3] and insufficient
malignant tumors and systemic infection [7].
development of the retromolar space [4] with the
Eruption status, position and angulation have
tooth either partly visible/in communication with
an impact on these sympotoms and pathologies. A
the oral cavity or completely invisible.
partially erupted, vertical angulated mandibular
The principal teeth that present as impactions
third molar, at or near the same level of adjacent
are either third molars or canines. The prevalence
second molar, is considered to have a high risk for
of impacted teeth varies among different
developing pericoronitis [8]. Likely, a partially
populations depending on the age group,
erupted, mesioangular or horizontal angulated
assessment method, and diversity within the sample
mandibular third molar that contacts the
population [5]. Mandible third molars are considered
amelocemental junction of second molar could give
to be the most commonly impacted teeth. Third
rise to caries development [9] and bone loss at the
molar impaction is reported to occur in 18% to 32%
distal surface of a second molar [10].
2130
Received: 20/12/2017 DOI: 10.12816/0045040
Accepted: 30/12/2017
c:\work\Jor\vol7012_18
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2137-2147
Comparative Study between Intra-operative Ventilatory
Techniques to Prevent Postoperative Pulmonary Complications
in Obese Patients Undergoing Laparoscopic Surgery
Galal A El Kady, Nevine A Kaschef, Khaled M Khalaf, Marwa M Mohamed,
Doaa M Awad Allah
Department of Anesthesiology, Intensive Care and Pain Management
Faculty of Medicine, Ain Shams University
Corresponding author: Doaa M Awad Allah; Mobile:01000244735; E-mail: do3a2mos3ad@gmail.com
ABSTRACT
Background: Managing ventilation and oxygenation during laparoscopic procedures in morbidly obese
patients undergoing surgery represents many challenges. There is no specific guideline on the ventilation
modes for this group of patients. Although several studies have been performed to determine the optimal
ventilatory settings for those patients, the answer is yet to be found. The aim of this study was to determine
which mode of ventilation is more effective in improvement of intraoperative oxygenation and prevention of
postoperative pulmonary atelectasis with its consequences is PEEP 10cmH2O alone is effective or
Recruitment maneuver followed by PEEP 10 cmH2O has better results.Aim of the Work:The study will be
performed to compare different intra-operative ventilatory techniques that prevent early postoperative
pulmonary complicationsespescially atelectasis in obese patients undergoing laparoscopic surgery.Patients
and Methods:Thisprospective, interventional, therapeutic, randomized clinical studywas conducted at Ain
Shams University Hospitals, operating theatre department on 100 morbidly obese adult patients of ASA
physical status II, admitted to Ain Shams university hospital, scheduled for elective laparoscopic surgery
either bariatric or non bariatric. The study was carried out after approval of the departmental ethical
committee.The patients were subdivided into 4 groups A, B, C and D, (25) patients for each group. Results:
Regarding the value of PO2/ Fi O2, there is no statistically significant difference between all groups in the
preoperative and intra operative values. But there is statistically significant increase in group D and group C
respectively compared to group A and B in both post operative and 6 hours post operative values. Regarding
CT chest,Group A showed the highest number of both lobar and segmental atelectasis followed by group B
which showed also a high number of segmental atelectasis. In despite, group C showed a higher number of
plate and lamellar atelectasis followed by group D that showed a high number of lamellar atelectasis but the
lowest number of other atelectasis scores. Conclusion: In conclusion, repeated Recruitment Maneuvers
combined with 10 cmH2O of PEEP have beneficial effects on oxygenation continued into the early recovery
period and decrease pulmonary complications in the early post operative period in morbid obese patients
undergoing laparoscopic surgery. Recommendations: Further studies on a larger scale of patients are
needed to confirm the results obtained by this work.
Keywords: intraoperative ventilatory, pulmonary, obese, laparoscopic surgery.
INTRODUCTION
preserves pulmonary function when compared to
The number of obese patients undergoing
open surgery, laparoscopic surgery also decreases
surgery is increasing, the pathophysiological
cardiac and wound complications and reduces
changes induced by obesity make these patients
organ- system impairment, the hypermetabolic stress
prone to peri-operative complications espescially
response of surgery that lead to increase myocardial
pulmonary complications which are the main
O2 demand, energy expenditure, pulmonary work
cause of overall peri-operative morbidity and
load and renal work load, is also attenuated in
mortality following general anesthesia. Pulmonary
laparoscopic surgery as the magnitude of this stress
complications include atelectasis, carbon dioxide
response is directly related to the magnitude of
retention and pneumonia, these complications
tissue injury (2).
may extend to the postoperative period leading to
Obese patients are more prone to develop
delay discharge from post anesthesia care unit,
pulmonary atelectasis due to decreased chest wall
increase the need for respiratory physiotherapy or
and lung compliance, and decreased functional
non- invasive ventilation and also increase the
residual capacity with impairment of pulmonary
probability of intensive care unit admission.
gas exchange and subsequent hypoxia, These
Prevention of these complications would improve
changes often occur after induction of general
the quality of medical care, decrease hospital stay
anesthesia and may persist for 24 hours (hr) post
and costs (1). Reduction in peri-operative morbidity
operatively, the degree of hypoxemia is directly
is the major advantage of laparoscopic surgery, as it
related to Body Mass Index (BMI)(3).
2137
Received: 20/12/2017 DOI: 10.12816/0045042
Accepted: 30/12/2017
c:\work\Jor\vol7012_19
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2148-2151
Causes and Management of Cellulitis
Khalifa May'ouf Albuainain1, Abduljabbar Abdullah Aljuwayd1, Ahmed Abdullah Almarzouq2,
Zainab Ali A. Abu AlSaud3, Nouf Abdullah Maziad Alkhattaf4, Eman Ahmed Alabdrabalrasol1,
Nedaa Ahmed Zamzamy5, Abbas Hassan Al-Lashit6, Mahdi Hussain Al-Saad7
1 Imam Abdulrahman bin Faisal University, 2 Medical University of Gdansk,
3 Dammam Primary Health Care, 4 Al Yamamah Hospital, 5 Maternity and Children Hospital Makkah,
6 Hamdard University, 7 King Faisal University
ABSTRACT
Background: Cellulitis is a diffuse, deep, acute inflammation of the skin including the dermis and subcutaneous
tissue. It often follows an acute or chronic trauma, and is an important cause of hospital admissions. About 10%
of infections-related hospital admissions in the US annually are due to cellulitis. The most common cause of
cellulitis is group A streptococci.
Aim: of this review was to study the common causes of cellulitis, and understanding the approach to its
management. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed,
and EMBASE, January 1983, through February 2017. The following search terms were used: cellulitis, soft tissue
infection, etiology of cellulitis, investigation of cellulitis, management of cellulitis, resistant cellulitis
Conclusion: Cellulitis is a common cause of infection-related hospital admissions worldwide. Mild cases can
resolve with empiric antibiotic treatment, whereas moderate or severe diseases are harder to treat and are
associated with higher recurrence rates. Recurrence rates can be minimized by treating predisposing factors like
obesity, lymphedema, and skin injuries.
Keywords: cellulitis, soft tissue infection, streptococcal skin infection, MRSA skin infection
INTRODUCTION
The definition is cellulitis is a diffuse, deep, acute
resolved by consensus. Studies were evaluated for
inflammation of the skin including the dermis and
quality and a review protocol was followed
subcutaneous tissue. It often follows an acute or
throughout.
chronic trauma, and is an important cause of hospital
admissions. In fact, it was estimated that about 10% of
Pathology
infections-related hospital admission in the US, and
Cellulitis occurs when an infectious organisms
up to 14 million outpatients' visits annually were due
invades the dermis of the skin (usually through a
to cellulitis [1]. On the other hand, the over-diagnosis
break). This disruption of the skin can result from
of cellulitis is also considered an important health
several causes including fungal infections (like
issue as it may cause the delay of proper management
onychomycosis, and tinea pedis), venous leg ulcers,
and treatment of the disease. A reason for this is that
pressure ulcers, and web spaces. The natural presence
physicians do not usually consult dermatologist until
of low temperature, low pH and skin flora play an
standard therapy fails. However, changing of this
important role in reducing pathogenic colonization on
behavior will lead to early proper diagnosis and
the skin surface [3].
management which will reflect as a significant
Under the microscope, cellulitis is characterized
improvement in care [2].
by lymphatic dilation, dermal edema, along with
METHODOLOGY
diffuse, heavy neutrophil infiltration around blood
· Data Sources and Search terms
vessels. Histiocytes, lymphocytes, and granulation
We conducted this review using a comprehensive
tissue may be observed in late cases [4].
search of MEDLINE, PubMed, and EMBASE,
When performing biopsy or needle aspiration,
January 1983, through February 2017. The following
cultures are usually negative or yield a low
search terms were used: cellulitis, soft tissue infection,
concentration of bacteria. This leads to the assumption
etiology of cellulitis, investigation of cellulitis,
that the initial inflammatory process can be induced
management of cellulitis, resistant cellulitis
by a relatively small number of bacteria. Another
· Data Extraction
possible explanation is that the number of viable
Two reviewers have independently reviewed the
bacteria is reduced significantly by the actions of an
studies, abstracted data, and disagreements were
intact immune system. Therefore, bacterial load does
2148
Received: 20/12/2017 DOI: 10.12816/0045043
Accepted: 30/12/2017
c:\work\Jor\vol7012_20
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2152-2156
Lifestyle Modifications for Hypertension Management
Sukaynah Adnan Salman Alsaigh1, Malik Dham Alanazi2, Mohammed Ayedh Alkahtani3,
Tahani Saleem Alsinani4, Ahmed Anis Abdullah5, Talal Abdullah Alghamdi6,
Eman Ahmed Alabdrabalrasol1, Thikra Abdullah Alzahrani4
1 Imam Abdulrahman bin Faisal University, 2 King Faisal University, 3 King Salmon Hospital, 4 Battarjee
Medical College for Science and Technology, 5 Umm Al-Qura University, 6 Faisaliah Primary Health Care
Corresponding Author: Sukaynah Adnan Salman Alsaigh - Dr.Sukaynah@Gmail.Com - 0549779145
ABSTRACT
Background: Hypertension is often not taken seriously by patients due to its chronic and silent nature.
Establishing a proper managing plan that leads to sufficient control of blood pressure will result in the
prevention of most complications and comorbidities associated with hypertension. The most important aspect
of long term management of hypertension lies in lifestyle modification which includes diet, exercise, and
social habits. Non-pharmacologic therapy plays an essential role in reducing blood pressure as well as in
preventing the development of hypertension in normal individuals. Aim of the work: this review was to
explore the various modifications a patient can make in lifestyle to maintain and manage blood pressure to
achieve a better quality of life.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 1976, through February 2017. The following search terms were used: hypertension,
management of hypertension, lifestyle modification, exercise, Mediterranean diet, non-pharmacological
management of chronic disease. Conclusion: Even a small decrease in blood pressure can lead to huge
benefits on a public health scale. Current evidence supports the application of lifestyle modifications to control
blood pressure. These modifications include the control of all possible related factors in order to achieve
optimal blood pressure which includes sodium intake, dietary modifications such as Mediterranean diet and
reducing alcohol intake, exercise, smoking cessation, and meditation. Family physicians must play a very
important role in educating, counseling, and encouraging patients about the benefits of these modifications and
their impact in over-all health.
Keywords: hypertension, management of hypertension, lifestyle modification, exercise, non-pharmacological
management of chronic disease
INTRODUCTION
Due to its silent and chronic nature, hypertension
hypertensive patients. Other recommendations
is usually not taken seriously by patients leading to
include limited alcohol consumption and increased
poor control, despite its strong association with
physical activity. Diet should contain reduced
severe morbidities and high mortality, mainly as a
amounts of sodium and fat. Fresh fruits, vegetables,
result of cardiovascular diseases. This silent nature
and legumes are among the most recommended
makes patients sometimes unaware of themselves
nutrients [3].
having the disease. A survey that was done from
Non-pharmacologic therapy (also known as
1985 to 1992 in Canada concluded that in the age
lifestyle modification) plays an essential role in
group between 18 and 74 years old, 22% had
reducing blood pressure and even preventing the
hypertension, and about half of them were not aware
development of hypertension in normal individuals.
of this, about one fifth of them were not treated
Life style modification should be the first step in any
although they were aware, and only about 10% were
hypertensive patient before the initiation of
controlled [1].
pharmacologic therapy and must be continued even
Establishing a proper managing plan that leads to
after starting long-term drugs. Even patients with
sufficient control of blood pressure will result in the
drug-controlled hypertension, proper life-style
prevention of most complications and comorbidities
modification can allow the reduction or even
associated with hypertension. The most important
withdrawal of drugs when patients are highly
initial step when managing a hypertensive patient is
committed to the new changes. Life style
lifestyle modification [2]. Increased weight, high
modifications are also important in non-hypertensive
sodium intake, physical inactivity, and consumption
individuals especially those at higher risks, to
of large amounts of alcohol, are all associated with
prevent later development of hypertension. These
significant elevation of blood pressure. The most
lifestyle modifications can have a significant effect
important lifestyle-related factor is weight; therefore
on the general mortality rates, even if they seem
experts recommend keeping the body mass index
simple. For example, a reduction in systolic blood
(BMI) less than 25 kg/m2 when dealing with
pressure as small as 3-mmHg can result in a 5%
2152
Received: 20/12/2017 DOI: 10.12816/0045044
Accepted: 30/12/2017
c:\work\Jor\vol7012_21
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2157-2161
Effectiveness of Psychological Intervention in Management of
Postpartum Depression
Abdulrahman Abdulkhaliq Abdullah Alshehri (1),
Husam Mohsen bin Alhasel (2), Hiba Salah Abdelgadir(3)
1-Faculty of Medicine, Albaha University, 2- Ibn Sina National College for Medical Studies,
3- Family Medicine, UMST University
Corresponding author: Abdulrahman Abdulkhaliq Abdullah Alshehri, Email: a.a.a.z.1412@hotmail.com
ABSTRACT
Background: In order to prevent postpartum depression many primary preventive programs were done.
Psychological interventions are thought to be effective in decreasing the incidence of postnatal depression. This
study aimed to evaluate the effect of Psychotherapy in treatment of postpartum depression.
Methods: An electronic search was obtained in MEDLINE and EMBASE databases with search terms such as
psychology, postpartum, depression, intervention, effectiveness. The primary search resulted in 128 studies
which have been screened for eligibility. After exclusion of irrelevant, duplicated and review studies, 11 studies
were included in the review as they met the inclusion criteria.
Results: Psychotherapy decrease the likelihood of postpartum depression and decrease postpartum depressive
symptoms, increased awareness, depression reduction, general improvement and psychological health and
prevention of postpartum depression, improve depression, functioning and anxiety. Training for health visitors'
intervention was found to be cost-effective in reducing the proportion of women at risk. It was only noted that
there was no outcome difference between behavioral approach and person-centered approach groups. Health
visitor raining was noted to have preventive effect for depression.
Conclusions: There is evidence to recommend that interventions carried in pregnancy can be effective in
preventing postnatal depression. Interventions are mainly effective when grounded on psychological treatments
and provided to women suffering from antenatal depression.
Keywords: Psychology, Postpartum, Depression, Intervention, Effectiveness.
INTRODUCTION
therapy (12, 13). In order to prevent PPD many primary
Postpartum depression (PPD) also known as
preventive programs were done. Psychological
postnatal depression, is a mood disorder that can occur
interventions are thought to be effective in decreasing
in women associated with childbirth (during the six
the incidence of postnatal depression (5). Many studies
weeks of the puerperium) (1). Symptoms of PPD
were conducted aiming to evaluate the effect of
include anxiety, irritability, guilt, feelings of extreme
Psychotherapy in treatment of PPD (14). Interestingly, it
sadness, exhaustion, sleep disorders and somatic
was noted that postpartum interventions to prevent and
symptoms that affect the mother, children and the
treat PPD were more effective than interventions that
whole family (1, 2). PPD is a global phenomenon that
done in the prenatal and antenatal periods (15).
affect large number of women every year. In 2013
The aim of the present systematic review is to
about 8.5% 11% of women were diagnosed with
assess all randomized control trials that studied the
depression during pregnancy (3). The exact cause of
effectiveness of psychological intervention in
PPD is unknown, but it thought that combination of
management of postpartum depression to review the
physical and emotional factors which play an
type of the psychological interventions and to examine
important role in its etiology (1, 4). PPD has many risk
its effects on patients' outcome. This review will
factors such as lack of partner support, single marital
provide evidence-based data that can help doctors to
status, recent stressful life events, low levels of social
improve their patients' outcome by applying the best
support and few number of children. In addition, the
evidence treatment modalities.
previous major depression is considered a risk factor
METHODS
to develop postnatal attack of depression (5-8). Many
An electronic search was obtained in MEDLINE and
studies found that mothers who were satisfied with
EMBASE databases with search terms such as
their families are less likely to develop PPD, and the
psychology, postpartum, depression, intervention,
vice versa (9-11). Both counseling and medications are
effectiveness. The primary search resulted in 128
used in the treatment of PPD. selective serotonin
studies which have been screened for eligibility. After
reuptake inhibitors (SSRIs) is a drug of choice in the
exclusion of irrelevant, duplicated and review studies,
treatment of PPD. Many types of counseling and
11 studies were included in the review as they met the
psychological therapy were used in treatment of PPD
inclusion criteria. Included studies aimed to assess the
such as; cognitive behavioral therapy (CBT),
effectiveness of psychological interventions in
interpersonal psychotherapy (IPT) and psychodynamic
2157
Received: 20/12/2017 DOI: 10.12816/0045045
Accepted: 30/12/2017
c:\work\Jor\vol7012_22
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2162-2164
Knowledge About the Prevalence of Acne Scars, Skin Hyperpigmentation,
Chloasma and Freckles in Hail's Community, Saudi Arabia
Adnan Meteb Mohamed Almezani
College of Medicine University of Hail
Corresponding author: Adnan Almezani, E-mail: dr.adnan7777@hotmail.com, phone no: +966554877775
ABSTRACT
Background: despite the modern society, medical support and education about skin problems, skin problems
have been common in individuals living in Hail city.
Objectives: to assess the knowledge about the prevalence of common skin problems like acne scars,
pigmentation, chloasma and freckles in Hail's community, Saudi Arabia.
Methods: a cross-sectional study on the common skin problems was randomly distributed among men and
women in Hail city of Saudi Arabia from February to October 2017 involving 6032 participants.
Results: in (35.3%) have acne scars, (30.8%) don't have any skin problems, (26.7%) have pigmentation,
(11.2%) have chloasma and (5.5%) have freckles.
Conclusion: my result showed that huge number of participants are suffering from a specific skin problem.
Keywords: acne scars, pigmentation, chloasma, freckles.
INTRODUCTION
30% of patients have a family history of melasma.
Acne has a prevalence of over 90% among
Identical twins have been reported to develop
adolescents [1]and persists into adulthood in
melasma while other siblings under similar
approximately
12%14%
of
cases
with
conditions did not. Freckles are clusters of
psychological and social implications of high gravity
concentrated melaninized cells which are most easily
[2, 3]. All body areas with high concentrations of
visible on people with a fair complexion. Freckles do
pilosebaceous glands are involved, but in particular
not have an increased number of the melanin-
the face, back and chest. Inflammatory acne lesions
producing cells, or melanocytes, but instead have
can result in permanent scars, the severity of which
melanocytes that overproduce melanin granules
may depend on delays in treating acne patients. The
(melanosomes) changing the coloration of the outer
prevalence and severity of acne scarring in the
skin cells (keratinocytes). As such, freckles are
population has not been well studied, although the
different from lentigines and moles [7].
available literature is usually correlated to the
Hyperpigmentation can be caused by sun
severity of acne [4]. 2133 volunteers aged 18 to 70
damage, inflammation, or other skin injuries,
from the general population showed that nearly 1%
including those related to acne vulgaris]8, 9, 10 [ .
of people had acne scars, although only 1 in 7 of
People with darker skin tones are more prone to
these were considered to have "disfiguring scars" [5].
hyperpigmentation, especially with excess sun
Severe scarring caused by acne is associated with
exposure [11]. Many forms of hyperpigmentation are
substantial physical and psychological distress,
caused by an excess production of melanin [11].
particularly in adolescents. Chloasma is a required
Hyperpigmentation can be diffused or focal,
hypermelanosis of sun-ex-posed areas and it can
affecting such areas as the face and the back of the
affect 5070% of pregnant women. It presents as
hands. Melanin is produced by melanocytes at the
symmetric hyperpigmented macules, which can
lower layer of the epidermis. Melanin is a class of
confluent or punctuate. The most common locations
pigment responsible for producing color in the body
are the cheeks, the upper lip, the chin and the
in places such as the eyes, skin, and hair. As the
forehead [6]. Chloasma is a synonymous term
body ages, melanocyte distribution becomes less
sometimes used to de-scribe the occurrence of
diffuse and its regulation less controlled by the body.
melasma during pregnancy. Chloasma is derived
UV light stimulates melanocyte activity, and where
from the Greek word chloazein, meaning »to be
concentration
of
the
cells
is
greater,
green. « Melas, also Greek, means »black. « Since
hyperpigmentation occurs. Another form of
the pigmentation is never green in appearance,
hyperpigmentation
is
post
inflammatory
melisma is the preferred term. Chloasma is more
hyperpigmentation. These are dark and discolored
common in women than in men, and women are
spots that appear on the skin following acne that has
affected in 90% of cases. It can affect 5070% of
healed.
pregnant women. Melasma is rare before puberty.
Persons of any race can be affected. However,
MATERIALS AND METHODS
it is much more common in constitutionally darker
A cross-sectional study involving 6032
skin ty- pes than in lighter skin types. More than
participants from Hail city of Saudi Arabia was done
2162
Received: 20/12/2017 DOI: 10.12816/0045046
Accepted: 30/12/2017
c:\work\Jor\vol7012_23
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2165-2171
The effect of Walking Exercise on Depressive
Symptoms: A Cross Sectional Study
Abdulrahman Alnasyan, Abdulaziz Alareefy, Nader Alrahili
Imam Muhammad Ibn Saud Islamic University College of Medicine
ABSTRACT
Background: Depression is a common mental disorder. It is managed by anti-depressant drugs, psychother-
apy sessions or both. Physical activity may improve depressive symptoms.
Objectives: We aim in this study to know the effect of walking on depression and depressive symptoms and
the relationship between walking and depression among Arabic population.
Materials and method: an online cross sectional survey, written in Arabic language targeting both males
and females' living in Saudi Arabia from age 18 and above, we used the Major depressive disorder criteria
according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to saasaa depression with other
questions about physical activity (30 minutes or more per session in last twelve months).
Result: 870 participants, 51.7% female and 48.3% male. Of the total participants 43.2% are not walking
regularly and 56.8% are walking on regular basis. Of total 63.8% are not depressed, while 11.6% are suffer-
ing from depressive symptoms and 24.6% are suffering from Major depressive disorder. In the group who
are not depressed 22.5% are not walking and 77.5% are walking regularly. Among those who walks, 18.8%
are walking once per week, 18.1% are walking twice per week, and 63% are walking three times or more per
week. In the group who are having depressive symptoms 77.2% are not walking regularly while 22.8% are
walking regularly 3 times or more per week, In the group who are suffering from major depressive disorder
80.8% are not walking and 19.2% are walking regularly. Among those who walks, 61% are walking once per
week, 36.6% are walking twice per week, and 2.4% are walking three times or more per week.
Conclusion: These findings underscore the need for increasing awareness of impact of physical activity in
psychological well-being. Further controlled study may focus on possibility of Brain changes secondary to
physical activity.
Keywords: Exercise, Walking, Depression.
INTRODUCTION
usually managed by anti-depressant drugs, psycho-
Depression is a common mental disorder.
therapy sessions and sometimes it needs both
People who are depressed may suffer of sadness
modalities (2). Walking is simple, free and ideal for
and they may lose enjoyment of life (1). Feeling
people of all ages and fitness levels (9). It is a safe
guilty is one of the Major Depressive Disorder
and beneficial for weight maintenance (10). Physical
criteria as well as low self-esteem and feeling
activity such as walking 30 min for at least 3 times
worthlessness. World health organization estimat-
per week has a positive effect on mental health (11,
ed that there are 350 million people suffer from
12) and on overall health as it is associated with
depression. The impact of the illness to function-
decreased incidences of high blood pressure, type
ality made it a leading cause of disability world-
2 diabetes, asthma and heart diseases (13).
wide (2).
A systematic review of benefits of outdoor
The world health survey conducted by WHO
walking groups found that walking has a positive
on 245404 participants shows the impact of de-
effect on measures of health such as blood pres-
pression in wellbeing is much worse than the
sure, heart rate, total cholesterol and depression
chronic conditions like diabetes, asthma and arthri-
(14). A prospective study done on 18344 elderly
tis,(3) and it is associated with increased risk of
women found that there is a strong relationship
coronary heart disease (4) and with increased risk of
between walking and both physical and mental
developing dementia (5). A prospective observa-
wellbeing in older women (15).
tional study found that depression seem to increase
A preliminary study found that walking in na-
danger of death in non-cardiovascular disease and
ture and outdoor walking have positive impact on
as risk factor for all-cause mortality (6). Depressed
depression and lower depressive symptoms and
people have higher risk of becoming overweight
mental health (16, 17). Another 2 studies found that
(7). A population-based cohort study of risk of
walking has positive effect on depression in post-
depressive disorder among contacts of tuberculosis
menopausal women (18, 19). A cross sectional study
patients in a TB-endemic Area found that the
of walking, body mass index, and self-rated health
people contact with tuberculosis have higher risk
in a representative sample of Spanish adults found
of developing depression disease (8). Depression is
2165
Received: 20/12/2017 DOI: 10.12816/0045047
Accepted: 30/12/2017
c:\work\Jor\vol7012_24
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2172-2177
Blockage of HCN Channels with ZD7288 Attenuates Mechanical
Hypersensitivity in Rats Model of Diabetic Neuropathy
Hussain Abdulaziz Alturki 1, Abdulmalik Abdulaziz Alkhamis 2,
Abdulaziz Mohammed AlEessa 3, Ahmed Sami Alwesaibie 4
King Faisal University College of Medicine in Al-Ahsa, King Faisal University College of
Medicine in Al-Ahsa, King Faisal University College of Medicine in Al-Ahsa ,
King Faisal University College of Medicine in Al-Ahsa
ABSTRACT
Background: Diabetes is a chronic condition that affects millions of people worldwide. The disease can have
severeimpact on many systems of the human body particularly the nervous system. Indeed, chronic peripheral
nerve pain, also known as peripheral neuropathic pain (NP), is the most common complication caused by
diabetes. There have existed preclinical researches that were performed using different types of Rodents as
models of Chronic Pain. Such studies have proven that hypersensitivity to pain is caused, at least partially, by
increased excitability of primary afferent dorsal root ganglion (DRG) neurons that send the sensory
information from the periphery to the brain. However, the mechanism of this hyperexcitability is yet to be
known.
Aims: The primary aim of the continuing work is to examine the hypothesis that Hyperpolarization-activated
Cyclic Nucleotide gated (HCN) channels (that are known to regulate excitability of the neurons) are involved
in the pathophysiology of diabetic neuropathic pain (DNP).
Methods and Results: To examine this hypothesis, we used a rat model of diabetic neuropathy by 60 mg/kg,
i.p., of (streptozotocin (STZ), a toxin of pancreatic -cells that release insulin), and tested the effects of
blocking the HCN channels with a selective blocker, ZD7288, on two pain behaviours (mechanical
hypersensitivity/allodynia, and heat hypersensitivity/hyperalgesia) in these STZ treated rats. The results
showed that intraplantar administration of ZD7288 (100 M) reduced mechanical allodynia but not heat
hyperalgesia.
Conclusions: The results are in agreement with previous investigations which used other models of chronic
pain, and suggest that HCN channels may be a good target for developing new analgesics (pain killers) for
chronic pain.
Keywords: HCN channels , ZD7288 , Mechanical hypersensitivity, Rats model ,diabetic Neuropathy.
INTRODUCTION
and spontaneous pain (unprovoked pain) 3. These
Pain is an unpleasant feeling perceived by the
manifestations frequently occur with an abnormal
brain. The pain signal is normally conduced from
loss of stimulus-evoked sensation, and they can last
the periphery to the CNS via sensory nerve fibers
for many years or even a life time, and severely
which responds to the painful stimuli. Pain is
impair the quality of life for DNP patients.
usually categorized into acute pain or physiological
Although there are many drugs that are used to
pain which is considered as `good` pain because it
control DNP in patients, but effective therapy for
plays a protective role, and chronic `bad` pain
DNP is still a clinical challenge due to the available
which plays no useful function and can last for
drugs not being effective or having significant
years or even an entire life time. Chronic pain may
adverse side effects. Therefore, there is a need to
last for over three to six months or even beyond the
understand the pathophysiology of DNP in order to
point of tissue healing1. Thus, chronic pain that
develop appropriate alleviative strategies.
affects around 20% of adults worldwide is a major
health problem. Chronic peripheral neuropathic
Neuropathic pain including DNP is believed to be
pain is associated with many types of
partly caused by abnormal hyperexcitability of
injury/diseases, including diabetes which affects
sensory dorsal root ganglion (DRG) neurons. Many
over 100 million people worldwide. Indeed diabetic
ion channels may be involved in this
neuropathic pain (DNP) is the commonest diabetic
hyperexcitability. These include :
complication. About 50% of diabetic people have
neuropathic pain2. The clinical symptoms of
Hyperpolarization-activated Cyclic Nucleotide-
patients with DNP include allodynia (pain caused
gated (HCN) channels, which produce an inward
by normally painless stimuli), hyperalgesia
stimulatory current (termed Ih in neurons) that
(increased pain caused by normally painful stimuli)
depolarizes the membrane potential toward the
2172
Received: 20/12/2017 DOI: 10.12816/0045048
Accepted: 30/12/2017
c:\work\Jor\vol7012_25
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2178-2182
Reliability and Validity of Field Testing of the World Health Organization
(WHO) Questionnaire about Knowledge, Attitude and Practices
(KAP) Towards Zika Virus Among Pilgrims (2017-Season)
Sami A. Alsalmi, Ahmed A. Alsalmi, Hamad S. Alosaimi,
Mohannad A. Alattar, Sultan S. Algethami
*School of Medicine, Taif University, Taif, Makkah, Saudi Arabia.
Corresponding author: Sami A. Alsalmi, E-mail: sami.aali.alsalmi@gmail.com
ABSTRACT
Background: ZIKA virus is a known public health emergency of international concern. The mass gathering
places like Hajj are the most viable environment for transmission of such virus.
Aim of the work: this study aimed to determine the reliability, validity and conduct the field testing of the
field testing of Arabic version of WHO-KAP questionnaire.
Material and Methods: this was a cross-sectional study in which the Arabic version of WHO-KAP
questionnaire was tested in the field of Al-Hajj season in 2017 by using multistage clustering sampling method
and retested online in the period from 23rd of August, 2017 till 20th of September, 2017.
Results: a total of 399 pilgrims from 11 countries were included with 61.4% that were females. The age of the
subjects ranged from 16 to 56 years old with means of 23.47± 14.19 and 15.49± 16.87 for males and females,
respectively. Internal consistency was measured using Alpha Cronbach's test which was 0.858. Test reliability
was measured by Intra Class Correlation Coefficient (ICC) that was 0.858. Kaiser-Meyer-Oklin Measure of
Sampling Adequacy (KMO-test) was done and showed a significant change (p-value= 0.0001). KMO
measured 0.871 which indicated a sufficient data to conduct the Factorial Analyses. Bartlett's Test of
Sphericity (Approximate Chi-square = 12714.212 , df =1485, p = 0.000). Loading of items of WHO-
KAP were >0.4 which led to preservation of all the chosen items.
Conclusion: the Arabic version of WHO-KAP questionnaire had good internal consistency. It can be used in
the future as field test.
Keywords: ZIKA virus, microcephaly, mass gathering, hajj, Saudi Arabia.
INTRODUCTION
ZIKA virus is a known Public Health
contact(7).There were several outbreaks of ZIKA
Emergency of International Concern. The rise in
virus, the largest was in May 2015, where the
the spread of Zika virus has been accompanied by a
Brazilian Ministry of Health estimated that between
rise in cases of microcephaly and Guillain-Barré
440,000 and 1,300,000 of the population are
syndrome. It was first identified in Uganda in 1947
suspected cases of ZIKA virus in Brazil(8). After the
in monkeys, Zika was later identified in humans in
outbreak of ZIKA in Brazil, it was clear that there
1952. The first large outbreak of disease caused by
is an increase in the incidence of ZIKA virus from
Zika infection was reported from the Island of Yap
0.5 cases per 10,000 births to 20 cases/10,000 births
in 2007. There were currently several
(9). ZIKA is also associated with Guillain-Barre
countries experiencing Zika virus outbreaks (1,2).
Syndrome (10).
The mass gathering places are the most viable
Combination of preventive measures included
environment for transmission of such virus. Hajj is
advice to aware the community about mosquito bite
considered to be the biggest gathering event of
protection measures can reduce the risk if ZIKA
people from over 180 countries and that is the
virus outbreak (11). In Saudi Arabia Aedesaegypti
major reason for investigating this field (3,4).
mosquito is present throughout the year and due to
ZIKA virus is a member of Flavivirus genus which
the mass gathering places in Saudi Arabia
also includes West Nile, dengue, yellow fever and
especially in Hajj and Umra there is a risk of
others. As a member of the Flavirirus genus, ZIKA
outbreaks, adding to that the lake of awareness
virus is a positive-sense, single-stranded RNA
among the public about preventing the transmission
genome which is enveloped and icosahedral virus.
of the disease (4).
(5,6). ZIKA transmitted through mosquito Aedes
This study aimed to determine the reliability,
subgenera, which can be transmitted through
validity and conduct the field testing of a WHO
modern transportation systems and also transmitted
published survey Arabic version of ZIKA virus in
from human to human through sexual
order to improve the awareness of the public in
2178
Received: 20/12/2017 DOI: 10.12816/0045049
Accepted: 30/12/2017
Pediatric airway management
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2183-2194
Impact of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone
Levels and Ovarian Stromal Blood Flow Using 2D Power Doppler in
Women with Anovulatory Polycystic Ovary Syndrome
Yehia A. Wafa1, Nehad E. Mousa2, Ahmed Shaaban M.1,
Amr A. AboAlyazid1
1- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
2- Department of Clinical Pathology, Police Authority Hospitals
Corresponding author: Amr Abo Alyazid, E-mail: amr_md3@yahoo.com
ABSTRACT
Aim of the work: this study aimed to evaluate the effect of laparoscopic ovarian drilling (LOD) on plasma
levels of anti-Müllerian hormone (AMH) and ovarian stromal blood flow changes, by using 2D power Doppler
ultrasonography, in polycystic ovary syndrome (PCOS), previously described as being clomiphene citrate
resistant and to evaluate the value of these parameters in predicting the clinical outcome of this line of
treatment. Patients and methods: this prospective controlled was conducted in Al-Hussien University
Hospital, Al-Azhar University and Police Authority Hospitals. This study was included twenty-three
anovulatory clomiphene citrate (CC)-resistant women with PCOS and 20 fertile women as a control group.
Laparoscopic ovarian drilling was done. Serum levels of hormonal profile were measured (AMH, LH, FSH,
LH/FSH ratio and total testosterone), ovarian stromal blood flow Doppler indices (RI and PI) and occurrence of
ovulation or pregnancy. Result: in this study we reported our findings regarding the effects of LOD on AMH,
hormonal profile and ovarian stromal blood flow in women with PCOS with Clomiphene resistance. These
results suggested that the measurement of AMH, LH, LH/FSH ratio, total testosterone, ovarian volume and
ovarian stromal blood flow by color Doppler were in discrimination of PCOS from potentially normal women.
The data in our study also suggested that there were no significant differences as regard AMH, hormonal
profile except total testosterone, ultrasound ovarian findings and ovarian stromal blood flow before and after
LOD, but there were significant differences as regard total testosterone before and after LOD. Also, there was
good predictive value for AMH after LOD for ovulation and clinical pregnancy. Conclusion: measuring AMH
for women with anovulatory PCOS undergoing LOD may provide a useful tool in evaluating the outcome of
LOD, but ovarian stromal blood flow 2D Doppler indices did not show significant changes predicting ovulation
or pregnancy rate after LOD.
Keywords: polycystic ovary syndrome, laparoscopic ovarian drilling, ovulation, anti-Mullerian hormone,
ovarian stromal blood flow.
INTRODUCTION
age and the most common cause of anovulatory
Anti-Mullerian Hormone (AMH) also
infertility, accounting for more than 70% of all
known as Mullerian Inhibiting Substance (MIS), is
cases (4) and affecting 5%-10% of females of
a member of the transforming growth factor ß
reproductive age (5).
family of growth and differentiation factors. In the
The diagnostic criteria of polycystic ovary
ovary, AMH has an inhibitory effect on
syndrome according to the Rotterdam concession,
primordial follicle recruitment as well as on the
2003 included any 2 of the following three
responsiveness of growing follicles to Follicle-
parameters: 1) oligo- and/or anovulation; 2)
Stimulating Hormone (FSH). The ovary-specific
clinical and/or biochemical signs of hyper-
expression pattern in granulosa cells of growing
androgenism and 3) polycystic ovaries by
non-selected follicles makes AMH an ideal marker
ultrasound and also with exclusion of other
for the size of the ovarian follicle pool (1). AMH
etiologies of hyper-androgenism (Congenital
serum levels were shown to be highly correlated
adrenal hyperplasia, androgen secreting tumors
with the number of antral follicles before
and Cushing's syndrome) (6).
treatment and number of oocytes retrieved upon
There had been much interest regarding the
ovarian stimulation (2) and had a better predictive
potential role of two dimensional (2D)
value than serum levels of FSH, inhibin B and E2,
transvaginal color Doppler ultrasound in assessing
and that the predictive values for AMH and antral
the intra-ovarian blood flow in women with
follicle count were almost identical. Similarly,
PCOS. Those women with PCOS had a significant
cycle day-5 AMH levels were better markers of
difference in intra-ovarian hemodynamics when
ovarian responsiveness than inhibin B levels (3).
compared to women having normal ovaries. The
Polycystic ovary syndrome (PCOS) is a common
intra-ovarian blood flow was assessed by studying
endocrine disturbance in women of reproductive
blood vessels in the ovarian stroma (Small arteries
2183
Received: 20/12/2017 DOI: 10.12816/0045050
Accepted: 30/12/2017
c:\work\Jor\vol7012_27
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2195-2197
A Case Report of Symptomatic Rathke's Cleft Cyst
Shahad Adraj1, Hanan Hiba 2, Mohammed Bahran3
1-Umm Al Qura University, Makkah, KSA, 2-King Abdulalziz Hospital, Makkah, KSA,
3- King Abdullah Medical City, Makkah, KSA
ABSTRACT
Background: Rathke's cleft cyst (RCC) is a not-so-common pituitary developmental disorder, it is a benign
growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the
anterior pituitary gland. Symptomatic cysts are very rare. With only few cases have been documented in the
literature. Aim of the work: this study aimed to assess the effect of corticosteroids on patients with
symptomatic Rathke's cleft cyst. Methodology: we reported a rare case of a 21 years old male patient, who was
referred from a primary health center to the endocrine clinic with the complain of decreased visual acuity,
blurred vision, and headache. On examination, there were no signs of puberty, no secondary sexual hair, truncal
and generalized obesity. The fundus examination showed bilateral temporal pallor, with pale disc and
papilledema. On the basis of symptoms and examination of the patient we suspected a lesion in the brain
obstructing the optic pathway and therefore suggested MRI. Conclusion: this case led us to conclude that
Rathke's cleft cysts should be considered in the differential diagnosis of patients who present with adrenal
insufficiency and that the cysts can be reduced by glucocorticoids.
Keywords: pituitary adenoma; Rathke's cleft cyst; magnetic resonance imaging.
INTRODUCTION
and the respiratory system examination were within
Rathke's cleft cyst is a benign congenital fluid
normal limits. The abdomen was soft, no lump or
filled cyst that is found between the anterior and
organomegaly, bowel sounds were present. Central
posterior parts of the pituitary gland (1). Symptomatic
nervous system examination showed no neck rigidity;
Rathke's cleft cyst is an extremely rare condition with
pupil bilateral reacting to light and plantar bilateral
only a few cases published in review literatures. Most
flexion. Examination of vision showed that the
of the cysts are usually asymptomatic and found only
patient had decreased peripheral visual field, the
on autopsy findings. Symptomatic cysts can trigger
fundus examination showed bilateral temporal pallor,
hormonal symptoms, visual disturbances and
with pale disc and papilledema. On the basis of
headache (2). Here, we reported a rare case of a patient
symptoms and examination of the patient we
with a symptomatic rathke's cleft cyst.
suspected a lesion in the brain obstructing the optic
pathway and therefore suggested MRI.
PATIENTS AND METHODS
A 21 years old male patient was referred from his
MRI brain study revealed enlargement of the
school to the Primary Health Center with decreased
sella with huge sellar and suprasellar region being of
visual acuity and blurred vision for two months. The
high signal intensity in T1\FLAIR, isointense in
family physician then referred the patient to the
T2w1 part from some heterogenicity at the poster
hospital for further investigations. Patient came to the
inferior aspect, the suprasellar component is
endocrine clinic and more detailed history revealed
measuring 2.72 * 2.02 CM and the sellar component
that the patient has frontotemporoparietal headache,
is measuring 2.73*2.5CM, the whole mass was
throbbing in nature intermittent and not relieved on
measuring 3.83CM in craniocaudal dimension, no
taking medication. He has mild bilateral papilledema
evidence of hemorrhagic component in gradient echo,
and visual filed defect. The patient was admitted to
no evidence of fat suppression on fat suppresses
the male medical ward for more investigation.
sequences, no evidence of definite enhancement after
The study was done after approval of ethical
IV contrast. This mass was exerting mass effect on
board of Umm Al Qura university.
the optic chiasm with superior displacement as well
as on the cavernous sinus with lateral displacement of
RESULTS
the internal carotid artery, however with normal
Examination showed that the patient was
caliber and signal intensity, inferior mass effect on
conscious, alert, oriented, afebrile, pulse rate 57/min,
sphenoid sinus and clivus. The pituitary gland and
blood pressure 110\75 mm Hg, height 150 CM and
stalk were not demonstrated, compressed by the
weight 70 kg. Patient's BMI was 31.1. There were no
above mentioned mass. The final impression: sellar
signs of puberty, no secondary sexual hair, truncal
and suprasellar mass as above described with MRI
and generalized obesity. The cardiovascular system
findings
suggesting
retake's
cleft
cyst.
2195
Received: 20/12/2017 DOI: 10.12816/0045051
Accepted: 30/12/2017
c:\work\Jor\vol7012_28
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2198-2201
Quality of Life in Chronic Hemodialysis Patients in
Al-Qurayat General Hospital
Mohammad Aqela Alazmi, Hisham Abid Aldabbagh
Al-Qurayat General Hospital
Corresponding author: Mohammad Aqela Alazmi, Email: moaqalazmi@moh.gov.sa
ABSTRACT
Background: hemodialysis process is a life-long intervention, involves multiple contributing factors to be
completed; including: scheduling of hemodialysis sessions, patient presence in hemodialysis unit, patient
family sharing and cooperation, availability and readiness of hemodialysis instruments and tools, availability,
cooperation and readiness of hemodialysis unit staff. Objective: this study aimed to promote the quality of
life in patients on chronic hemodialysis patients in Al Qurayat General Hospital in Saudi Arabia. We tried to
determine the factors that affect the quality of life.
Material and Methods: this was a descriptive, uncenter and non-interventional study. All patients had
chronic hemodialysis in Al Qurayat general hospital. A questionnaire contains all questions regarding the
objective of this study. Data were taken via interviewing 76 patients; 36 males, and 40 females aged 14 to
above 60. All patients were interviewed individually to fill the questionnaire directly. Results: 76 patients on
chronic hemodialysis in the Artificial Kidney Unit (AKU) in Al Qurayat Hospital were studies, 36 males and
40 females, their ages ranged between less than 14 to above 60, mean age 49.5 years, for some items
correlated with quality of their life affected by chronic hemodialysis through a special questionnaire was
designed for this purpose. Conclusion: male and female patients undergoing chronic hemodialysis were
almost equally in numbers. A considerable percentage of patients on chronic hemodialysis is lying in the
productive adult age group. Patients on chronic hemodialysis spend a considerable mean time per day to
undergo hemodialysis sessions, for undergoing a mean 11 sessions per month. All aspects of patients on
chronic hemodialysis life are affected negatively in most patients, either mildly or moderate to severe, and to
extreme extent occasionally; including personal, family, community/social, and occupational/professional
aspects.
Keywords: Chronic, Hemodialysis , Al-Qurayat General Hospital.
INTRODUCTION
OBJECTIVE: This study aimed to promote the
Hemodialysis
process
is
a
life-long
quality of life in patients on chronic hemodialysis
intervention, involves multiple contributing factors
patients in Al Qurayat General Hospital in Saudi
to be completed; including: scheduling of
Arabia. We tried to determine the factors that affect
hemodialysis sessions, patient presence in
the Quality of life.
hemodialysis unit, patient family sharing and
MATERIAL AND METHODS
cooperation, availability and readiness of
This was a descriptive, uncenter, and non-
hemodialysis instruments and tools, availability,
interventional study. All patients had chronic
cooperation and readiness of hemodialysis unit
hemodialysis in Al-Qurayat general hospital. A
staff, convenient time for both patient and
questionnaire contained all questions regarding the
hemodialysis unit, pre and post hemodialysis
objective of this study. Data were taken via
follow up, co-morbidity and patient health status
interviewing 76 patients; 36 males, and 40 females
impact, that actually have a considerable effect on
aged 14 to above 60. All patients were interviewed
patient life pattern and quality(1-5,8).
individually to fill the questionnaire directly. The
Many non-patient factors also may affect
study was done after approval of ethical board
hemodialysis process and consequently patient life
of Al-Qurayat General Hospital.
himself, including: family cooperation, social and
community support, governmental and non-
RESULTS
governmental promoters. Investigating the quality
76 patients on chronic hemodialysis in the
of life in patients on chronic hemodialysis will
Artificial Kidney Unit (AKU) in Al Qurayat
demonstrate the actual vital suffers of these
hospital were included, 36 males, and 40 females,
patients regarding all contributing factors
their ages ranged between less than 14 to above 60,
mentioned above or any other detected factors
mean age 49.5 year, for some items correlated with
through this study. Changing, regulating,
quality of their life affected by chronic
supporting, or eliminating some of these
hemodialysis through a special questionnaire was
contributing factors will help these patients enjoy a
designed for this purpose.The results of the
more effective and happier life.
questioned items could be demonstrated in the
following
tables:
2198
Received: 20/12/2017 DOI: 10.12816/0045052
Accepted: 30/12/2017
c:\work\Jor\vol7012_29
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2202-2208
The Interaction between Sleep Quality and Academic Performance
among The Medical Students in Taif University
Ayeshah Beeshi Alqarni , Nouf Jafar Alzahrani , Mohammed Ateih Alsofyani, Asim Abdulhadi Almalki
Faculty of Medicine, Taif University, KSA
Corresponding Author: Ayeshah Beeshi Alqarni,Email: ayshabq2012@gmail.com , telephone: +966509166782
ABSTRACT
Background: Sleep quality has significant effects on cognitive performance and physical power and is
influenced by multiple factors such as stress. Contrary to the ideal, medical students suffer from sleep
deprivation and stress at times when they should achieve the greatest amount of learning. However, poor sleep
quality may negatively impact test performance as well, creating a vicious circle. Aim of the study: this study
aimed to assess the relationship between sleep quality and academic performance among medical students in
Taif University. Methods: this descriptive, cross-sectional analytic study was conducted on 299 of Saudi male
and female medical students in Taif University, Saudi Arabia, who completed a self- administered survey by
using the Pittsburgh Sleep Quality Index (PSQI) and academic grades to collect data. Data were collected from
5-Feb-2017 to 28-May-2017.The analysis was performed using IBM SPSS statistics (v. 23). Results: a total of
299 medical students were included in this study and surveyed to check for any association between the quality
of sleep and their academic scores. Almost 56% of the participants were females. The highest percentage of the
participants were from 3rd year (30.4%) and the least were from the fifth year who represented only 9.4%. the
highest percentage of the participant had academic score between 3-3.5 and represent 36.5% , while those who
scored between 3.5 and 4 represented 34.8% of the group. The least were those who scored 2 or less they were
only 5 students (1.7%). The average sleep score for all the participants was 14.17(SD±2.7). There was a
significant difference in the sleep score between males and females (p value =0.04). The Females scored
higher (14.46±2.7) than the males (13.82±2.7) which means that the fames had slightly better sleep quality.
There was no significant difference in sleep quality between student from different academic years (p value =
0.97) and between students of different academic achievement (p value=0.99). There is no significant
correlation between the score representing the Quality of sleep and the academic score (p value =0.935).
Conclusions and recommendation: the sleep quality was negatively associated with academic performance
in medical students. Health education is recommended to improve quality of sleep and promoting lifestyles of
the students.
Keywords: sleep quality, academic performance , medical students in Taif university.
INTRODUCTION
sleepiness criteria, and 79.3% were poor sleepers
Sleep quality has significant effects on
while 43.3% had poor academic performance
cognitive performance and physical power and is
during the last semester. Sleep efficiency < 65%
influenced by multiple factors such as stress.
was statistically associated with poor academic
Contrary to the ideal, medical students suffer from
performance (P=.024; OR = 4.23; 95% CI, 1.12-
sleep deprivation and stress at times when they
15.42) in the multivariate analysis (2).
should achieve the greatest amount of learning.
However, poor sleep quality may negatively impact
In Saudi Arabia
test performance as well, creating a vicious circle
Study in Saudi Arabia showed that about (78.8
(1). There is increasing awareness about the
%) of students agreed that sleep deprivation
association of sleep quality and academic
negatively affects academic performance and (78.4
achievement among university students. However,
%) mood . Around 62.2 and 73.7 % of students
the relationship between sleep quality and academic
agreed that the demanding medical curriculum and
performance has been examined in Saudi before,
stress of final exams lead to sleep deprivation,
but not in Taif city, this study assessed the
respectively. While 36.7 % of students voiced the
relationship between sleep quality and academic
need for incorporation of curricular separate
performance among medical students at Taif
courses about healthy sleep patterns into medical
University. A study was conducted in 2012, 59% of
curriculum, a much greater proportion of students
all participants exhibited clinically relevant sleep
(45.9 %) expressed interest in extracurricular
disturbances during exam preparation compared to
activities about healthy sleep patterns. Interestingly,
29% during the semester and 8% post-exam (1).In
only 13.5 % of students affirmed that they were
another study in Spanish it wasfound that about
counselled about sleep patterns and academic
49.8% of students had Excessive Daytime
performance by their academic advisors (3).
2202
Received: 20/12/2017 DOI: 10.12816/0045053
Accepted: 30/12/2017
c:\work\Jor\vol7012_30
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (12), Page 2209-2213
Prevention and Control of HCV Infection and HCV Related Chronic Disease
Assma Khaled Salwy, Shuruq Mohammed Aljaafari
Jazan University
ABSTRACT
Background: Hepatitis C virus is an RNA virus that cause acute and chronic infection. The chronic infection
can cause progression to several critical diseases including liver cirrhosis and hepatocellular carcinoma. The
prevalence of the virus is increasing and as a result the related diseases and mortality increase. Prevention of
the new infections and treating the patients can result in decreasing in number of new cases and avoiding
mortality.
Aim: To study the prevention measures for HCV infection and its related chronic diseases.
Methods: Internet was used to search for articles related to the current subject using different keywords and
different scientific websites.
Results: There were 7 articles included in this review including both research and review articles.
Conclusion: HCV and its related chronic diseases can be prevented by several available strategies such as
increasing knowledge and awareness about HCV, screening of population under high risk and treatment of
patients.
Keywords: HCV prevention, HCV risk factors, Saudi Arabia, Recommendation for HCV.
INTRODUCTION
Hepatitis C virus (HCV) is an RNA virus which
chronic diseases, the present review is conducted to
is a positive strand, it belongs to the family
highlight the prevention strategies for HCV
Flaviviridae and Hepacivirus genus [1]. It causes
infections.
contagious serious and inflammatory diseases which
influence the function of the liver and may persist a
MATERIALS AND METHODS
chronic infection [2,3]. HCV infection is a main cause
We used the internet to search for articles about
of mortality and morbidity; also it can cause acute
our present subject, we used several websites
hepatitis and chronic liver diseases including
including ResearchGate, Google Scholar and Pubmed
cirrhosis, liver cancer, and chronic kidney disease [4].
using different keywords such as HCV Prevention,
It was reported that HCV infection will be the main
HCV risk factors, Recommendation for HCV
cause of liver cancer and chronic liver diseases [5,6].
prevention, and HCV in Saudi Arabia. We obtained
Infection of HCV is the most prevalent chronic blood
22 articles, we included 7 articles with publication
borne infection [7]. The burden of infection in the
date between 2012 and 2017 and we excluded the
world is increasing, although there are improvements
other articles as they didnt focus on our present
in transfusion practices and general health measures
subject.
for limiting the transmission of the virus [8].
HCV is a global major health problem which
Prevalence of HCV
affects more than 170 million, with 80 % persistent
There is a geographic variation in distribution of
chronic infection [4]. North Africa and the Middle
HCV infection, a higher prevalence can be seen in the
East are two regions of the highest prevalence of
Mediterranean, Latin America, East Asia, certain
HCV infection [9,10]. The prevalence of HCV in Saudi
areas in Africa and Eastern Europe [14]. Reports about
Arabia differs with different population groups, it was
HCV prevalence in Saudi Arabia are still inconsistent
reported to be 4.8%-84.6% among hemodialysis
among different studies as there are wide variations in
patients, 4.6%-78.6% in multi-transfused patients [11],
population included in each study [15]. The prevalence
4.6% among multi-transfused children [12].
of HCV in Saudi Arabia was reported in a review to
It was found that HCV was prevalent in 34% of
be 1.7%. HCV prevalence is varied among different
Egyptian blood donors in Saudi Arabia [13]. Saudi
population groups in Saudi Arabia [11], in one study it
Arabia is one of the gulf countries that mandated
was found that the prevalence among schistosomiasis
HCV
screening
before
obtaining
residency
patients was 11.8% [16], while it reached to 50%
permission [11], however it is still risk HCV infection
among infected hemodialysis patients [17]. In pregnant
transmission from migrants of other countries or
women, the HCV prevalence was found to be ranged
among Saudi themselves. HCV infected person is a
from 0.1 % to 4.6% [18,19]. In expatriates group living
source of infection transmission [7].
in Saudi Arabia, HCV prevalence was higher than
Prevention of HCV infection is the best strategy
among Saudi nationals. HCV was prevalent in 4.6% -
for HCV eradication and decreasing accompanied
70% among thalassemics [11]. In people who injected
2209
Received: 20/12/2017 DOI: 10.12816/0045054
Accepted: 30/12/2017