c:\work\Jor\vol702_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 187-191

Knee Replacement Surgery and Its Effect on Long Term
Omar Abdulmohsen Alshadokhi1, Ibraheem Abdullah Aldawod2, Althobaiti Thamer Abdullah3,
Fouad Taiwilaa Alshammari4, Matar Abdullah Alzahrani5, Ayat Adel Almusally2, Anas Mustafa
Makhdoum6, Mohammad Hamid Alfallaj7, Abdullaziz Ahmed Al-Darwesh8, Waleed Mohammed F.
Alsuwayh9, Khalifa May'ouf Albuainain2, Alaa Jameel Albarakati10, Ahmed Ali Almeshari8,
Meshal Abdullatif Almustafa8, Khalid Amin Abduldaem6
1 Imam Muhammad Ibn Saud Islamic University, 2 Imam Abdulrahman Bin Faisal University,
3 King Faisal Medical City, 4 University of Hail, 5 Medical University of Gdask,
6 Taibah University, Dow University of Health Sciences, 8 King Faisal University,
9 King Saud Bin Abdulaziz University for Health Sciences, 10 Alnoor Specialist Hospital
Corresponding Author: Omar Abdulmohsen Alshadokhi - Omaar1993@Windowslive.Com - 0500900924

ABSTRACT
The primary indication for total knee replacement is relief of significant, disabling pain caused by severe
arthritis. Total knee replacement surgery begins with correct planning of both the incision and the exposure
of the joint. Definitely, these are factors that are just as important to an optimal outcome as choosing the
right implant, positioning the components, and balancing the ligaments. While it is true that the standard
incision and arthrotomy will, in most primary implant cases, provide adequate joint exposure, it is also true
that cases characterized by certain conditions, such as previous cutaneous incisions, present specific skin and
exposure problems that need to be recognized, planned for and overcome.
Keywords: knee replacement, arthroplasty, deep vein thrombosis, tourniquet.

INTRODUCTION
contracture of ten degrees. A panel of clinical
Total knee replacement (TKR) was developed
specialists votes on the appropriateness of
in the 1970s and spread across referral centers and
recommending TKR in this scenario using a scale
then community hospitals in the 1980s and 1990s.
ranging from 1 (most inappropriate) to 9 (most
At the present time, total knee replacement use
appropriate). Scenarios receiving average votes of
surpasses 650,000 cases annually in the US and
79 are classified appropriate, 46 inconclusive and
many more worldwide [1]. Rates of utilization vary
13 inappropriate. The argument as to whether knee
markedly across hospital service areas, signifying
ligaments ought to be conserved or sacrificed
uncertainty amid physicians concerning signs for
continues to this day. Long-term follow-up studies
total knee replacement [2]. With TKR rates
do not show any significant differences, however,
projected to increase additional in coming decades
gait seems to be less abnormal if ligaments are
[3], it is sensible to ask whether total knee
conserved, particularly when walking up and down
replacements are being done today for suitable
stairs. One theoretical way of incorporating normal
indications.
kinematics and maximal conformity is with mobile
Normally, a procedure is considered
tibial bearings. Midterm follow-up studies of these
appropriate for a specific patient if the expected net
prostheses have shown encouraging outcomes.
gains surpass net harms [4]. This sounds simple
Cemented total knee replacements will continue the
enough but all patients are unique and available
criterion standard for TKA, but uncemented designs
literature does not allow a detailed accounting of
with bioactive surfaces (eg, hydroxyapatite) are
the short- and long-term benefits and harms
showing promising midterm results [6].
connected with the many distinct clinical scenarios
The primary indication for TKA is to get rid of
in which TKR is achieved. The Rand group
pain caused by severe arthritis. The pain ought to be
established an approach to address this challenge [5].
significant and disabling. Night pain is mainly
In the Rand approach, clinical characteristics that
distressing. If dysfunction of the knee is causing
affect the risks and benefits of surgery are identified
significant reduction in the patient's quality of life,
on the basis of published literature and expert
this ought to be taken into account. Correction of
opinion. The appropriateness of surgery is rated by
significant deformity is an significant symptom but
a panel of clinical experts for each of the clinically
is infrequently used as the primary indication for
plausible
combinations
of
these
clinical
surgery. Roentgenographic discoveries must
characteristics. For example, one scenario might
correlate with a clear clinical impression of knee
include a patient with age greater than 55, Kellgren-
arthritis. Patients who do not have significant loss
Lawrence (K-L) score of 4, severe pain and flexion
of joint space tend to be less satisfied with their

clinical result after TKA. Exhaust all conservative
187
Received: 08/10/2017 DOI: 10.12816/0043075
Accepted: 18/10/2017

Full Paper (vol.702 paper# 1)


Introduction The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 192-204

Role of MRI in Postoperative Assessment and Detection of
Recurrence in Cancer Rectum
Safaa Kamal Mohammad Bader-eldin*, Ali Haggag Ali Noreldien*, Mohammed Adil Ali**
*Radiodiagnosis Department, Ain Shams University and **Baghdad University
Corresponding author: Mohammad Adel, email: drmoh77@yahoo.com

ABSTRACT
Background:
rectal cancer constitutes about one third of all gastrointestinal tumor. High resolution MRI
plays a pivotal role in the post-operative follow up and also plays an important role in detection of
recurrence. It is the best modality to assess the relations of the rectal tumor and the potential circumferential
resection margin (CRM). Therefore it is currently considered the method of choice for local staging of rectal
cancer and follows up after total mesorectal excision (TME) and detection of residual or recurrent cancer.
Objective: the purpose of this study was to assess the accuracy of MRI in the postoperative assessment
rectal carcinoma and detection of recurrence.
Subjects and methods: twenty patients with pathologically proven rectal carcinoma underwent pelvic MRI
examination. Results: this study was conducted on twenty patients (13 male and 7 female) who underwent
surgical excision of pathologically proven cancer rectum. Patients were selected from outpatient's clinic and
Department of Surgery at the El-Demerdash Hospital. The patient's age ranges from 32 to 75 years old.
Conclusion: MRI of rectal cancer was accurate for post-operative assessment and had high sensitivity with
specificity in the detection of recurrence.
Keywords: rectal cancer, high resolution magnetic resonance imaging, postoperative assessment, detection
of recurrence.

INTRODUCTION

Rectal cancer ranks third amongst the most
chemo-radiotherapy provide tumor size and
frequently diagnosed tumors in the world, after
staging reduction in most extensive disease,
lung cancer and breast cancer (1). Operative rectal
increasing the possibility of attaining free margins
cancer management has been refined significantly
in surgery (4).
during the past 20 years. The main advance has
High resolution T2-weighted imaging is the
been the specialization and standardization of
key sequence in the magnetic resonance (MR)
mesorectal excision, pathological involvement of
imaging evaluation of preoperative assessment of
the circumferential resection margin (CRM)
primary rectal cancer, this technique allows
and/or an incomplete mesorectum excision are
differentiation between rectal tumors confined
predictors of local recurrence (2).
within the rectal wall (stage T2 tumors) and those
Currently, surgical resection with stage
that extend beyond the muscularis propria (stage
appropriate neo-adjuvant combined modality
T3 tumors) (3).
therapy is the mainstay in treatment of rectal
Post-operative MRI and diffusion-weighted
cancer. In the past decade, the increasingly
MRI (DW-MRI) has been reported high accuracy
widespread adoption of total mesorectal excision
for the diagnosis of locally recurrent rectal cancer
(TME) has resulted in a dramatic decline in the
as DW-MRI clearly discriminates the abnormal
prevalence of local recurrence from 38% to less
signal intensity of tumor from surrounding organs
than 10%. TME is a surgical technique that entails
such as the bowel or from fibrosis (3).
en bloc resection of the primary tumor and the
Moreover, the benefit of diffusion weighted
mesorectum by means of dissection along the
MRI is to detect small metastatic implants , it also
mesorectal fascial plane or the circumferential
proved to be valuable in the setting of associated
resection margin (CRM) (3).
sepsis or anastomotic leakage because it may
A study showed that high-resolution MR
differentiate between recurrence and inflammation
imaging was a reliable and reproducible technique
on the basis of morphological features on T2 or
with high specificity (92%) for predicting a
enhanced T1-weighted MR images (5).
negative CRM, the relationship of the tumor to the
MRI examination is based on T2-weighted
CRM and the depth of tumor invasion outside the
(w) fast spin echo (FSE) sequences acquired in the
muscularis propria (3).
sagittal, axial, and coronal planes using a 1.5
The presence of tumor at 1 mm or less from
Tesla MR unit. Gadolinium-enhanced Fat-
the fascia is directly related with local recurrence
suppressed FSE T1-weighted sequences may
and a poor survival rate. While, TME cures early
additionally be performed, as well as diffusion-
stages of the disease, preoperative radiotherapy or
weighted MR images (5).
192
Received: 20/9/2017 DOI: 10.12816/0043076
Accepted: 29/9/2017

Full Paper (vol.702 paper# 2)


c:\work\Jor\vol702_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 205-209

Medical Student's Knowledge of Ionizing Radiation and Radiation
Protection in Riyadh, Saudi Arabia
Tarik Anwar Rahmatullah*, Khalid Anwar Abo Alela, Khalid Saeed Alanazi
Almaarefa Colleges, Riyadh, Saudi Arabia
*Corresponding author: Tarik Anwar Rahmatullah, Email: Tarik_jhan@hotmail.com, Mobile no: +966534720056


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

INTRODUCTION
experience and knowledge of radiation doses of these
Radiological investigations have been widely used
investigations. This has been of concern among
in patient management and these investigations
faculty members in charge of undergraduate medical
involved exposing the patients to either ionizing, or
students, since this knowledge should already be
non-ionizing radiation. The number of investigations
developed at the undergraduate level [3-5].
involving ionizing radiation has dramatically
Since 1989 and up to date, several studies were
increased in the past decade. It was estimated that CT
questioning medical student's knowledge related to
examinations have increased in the USA by a factor
ionizing radiation and more research has been
of 10 from 1980-2005[1]. In the USA, CT
conducted on the topic. Some of them found that
examinations account for 13% of all diagnostic
student's knowledge of radiation safety is insufficient
exposure, but it was estimated to be responsible for
and hundreds of unnecessary examinations are
more than 70% of the collective radiation dose
performed every year due to this lack of knowledge.
delivered to patients [2].
They have emphasized that radiation protection
Advancement in technology has led to complex
should be mandatory and part of the medical school
interventional radiological procedures and nuclear
curriculum [3-10].All these disappointing results urged
medicine investigations. With these advancements,
O'Sullivan et al. [11] to investigate the effect of a
concerns regarding radiation dose to patients arise.
curriculum in clinical radiology that included
Although most of these exposures were justified, not
radiation protection. They assessed the awareness of
all of them were clinically useful. Today, patients are
all medical students (from years 1-5) of radiation
more aware that radiation can be harmful. During
exposure and studied the effect of clinical radiology
medical exposure from examinations involving
curriculum on their knowledge. They used a
radiation, doctors are the main source of information.
questionnaire that assessed radiation knowledge and
They have to be prepared and aware of the risks,
radiology teaching. First year medical student on
benefits and dose in order to provide an accurate
their first week of classes was used as a control group.
explanation to their patients. Doctor's justification of
Improvement in knowledge was found year after year
diagnostic imaging requests depends on their
in comparison with the control group. They
205
Received: 02/10/2017 DOI: 10.12816/0043077
Accepted: 12/10/2017

Full Paper (vol.702 paper# 3)


c:\work\Jor\vol702_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 210-214

Pneumonia in Rheumatoid Arthritis Patients
Mohammed Jamal Alofaisan 1 , Walaa Ali H Alkhalifah 2 , Mohammed Ahmed Yahya Alyamani 3 ,
Ali Hussain A ALDawod 4 , Burir Mansour Al Jassas 5 , Rana Mohammed M Nourah 6 , Afaf Meshal
Almjlad 7 , Hassan Ali A Al-Mubarak 4 , Sulaiman Alaa S Hanbazazah 6 , Abdulhameed Ibrahim
Alabdulhadi 1 , Esra Mohammed Omar Alsayed 8 , Bassam Adel Aljabri 9
1- King Faisal university , 2- Alexandria university , 3- Imam Muhammad ibn Saud University ,
4- Imam Abdulrahman bin Faisal university , 5- University of Dammam ( Imam Abdurahman Bin Faisal
University now ), 6- King Abdulaziz University , 7- Northern Border University ,
8- Jazan university, 9- Umm Al-qura universiy

ABSTRACT
Purpose:
The purpose of this study was to compare the clinical characteristics of pneumocystis pneumonia
(PCP) between patients with rheumatoid arthritis (RA) being treated with biologics and those being treated
without biologics. Methods: From 220 patients with RA in our institution, we enrolled 12 patients who had
developed pneumocystis pneumonia throughout the course of their management. They were divided into two
groups according to the treatment they were receiving for rheumatoid arthritis: the biologics group (n = 6)
and the nonbiologics group (n = 6). Clinical characteristics of pneumocystis pneumonia were compared
between the two groups. Results: At pneumocystis pneumonia diagnosis, the biologics group showed
significantly lower serum levels of -D-glucan and C-reactive protein than the nonbiologics group, whereas
the biologics group had significantly higher lymphocyte counts than the nonbiologics group. In the
nonbiologics group, lower lymphocyte counts were associated with higher -D-glucan levels; nonetheless,
this was not witnessed in the biologics group.
Conclusion: The finding that rheumatoid arthritis patients being treated with biologics developed
pneumocystis pneumonia with relatively normal lymphocyte counts and lower -D-glucan levels suggests
that the pathophysiology of pneumocystis pneumonia in those patients is different from that in patients being
treated with other antirheumatic drugs.
Keywords: rheumatoid arthritis, inflammatory disorder, pneumonia.

INTRODUCTION
with biologic agents in comparison with
Pneumocystis pneumonia (PCP) is a rare but
nonbiologic disease-modifying antirheumatic
critical complication in immunosuppressed patients

[1]. It was primarily revealed in human
medications. The purpose of the present study was
immunodeficiency virus (HIV) positive patients in
to clarify the differences in the clinical
the 1980s [2]. In the following years, PCP cases
characteristics
of
pneumocystis
pneumonia
enlarged in patients with rheumatoid arthritis (RA)
between patients being treated with biologic agents
being treated with disease-modifying antirheumatic
and patients being treated with nonbiologic
drugs (DMARDs), with high mortality rates
disease-modifying antirheumatic medications.
recorded [3, 4]. More lately, PCP cases have likewise

been reported throughout management with
MATERIALS AND METHODS
biologic agents targeted at precise molecules [5, 6].
The study was a retrospective, observational
Whereas
immunosuppressive
treatment
is
clinical study conducted at our institution with
recognized as a risk factor for the progress of
approval by the institutional ethics committee.
pneumocystis pneumonia, through lymphocyte
From a total of 220 consecutive patients with RA
count suppression [7], a former study described that
who visited our institution between August 2016
pneumocystis
pneumonia
might
develop
and November 2016, all patients who were
throughout management with biologic agents in
diagnosed with pneumocystis pneumonia were
patients with rheumatoid arthritis, without apparent
enrolled in the analysis.
lymphocytopenia [8].
PCP was diagnosed as definite when patients met
This recommends that distinct mechanisms can
all the following criteria [9]:
be intricate in the development of pneumocystis A- clinical manifestations and findings compatible
pneumonia throughout management with biologic
with PCP on chest computed tomography (CT),
agents. Nonetheless, little is known about the B- microscopic detection of pneumocystis jirovecii
differences in the clinical characteristics of
or positive polymerase chain reaction test results
pneumocystis pneumonia throughout treatment
210
Received: 09/10/2017 DOI: 10.12816/0043078
Accepted: 19/10/2017

Full Paper (vol.702 paper# 4)


c:\work\Jor\vol702_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 215-222

Prevalence of Factors That Can Increase the Risk of Hip Fracture and
Its Complications after Surgery
Saad Saleh Algarni, Meshari Musaad Almalki
Ibn Sina National College for Medical Studies, Jeddah, College of Medicine and Medical Science,
Taif University, Taif
Corresponding author: Saad Algarni, E-mail: dr.saadalgarni@hotmail.com

ABSTRACT
Background:
hip fractures are defined as any fracture of the femur between the articular cartilage of the hip
joint to 5 cm below the distal point of the lesser trochanter; they can occur at any age, they but are most
common in the older persons. A worldwide incidence hip fractures are 1.6 million osteoporotic fractures of
the hip in people aged 50 years and older in 2000, of which about 70% (1.14 million) were in women.
Objectives:
this study aimed to evaluate various postoperative complications and their risk factors in hip
fracture patients in King Fahad Hospital in Saudi Arabia.
Method: this prospective study enrolled patients with hip fractures who were subjected to hip fracture surgeries
in the king Fahad Hospital in the period from 1/5/2010 to 31/1/2016. Detailed medical history,perioperative
characteristics and post-operative characteristicswere collected from the patient's files.
Results: the higher prevalence of hip fractures was founded among elderly patients with age range of 65 74
years. There was no significant correlations between age, gender, comorbidities (diabetes mellitus, anemia and
walking of physical assistance), time of operation and post-operative complications (neurovascular, infection in
joints, dislocation of the joint, loosing of the joint and post-operative disabilities) regarding readmission of hip
fractures patients for the same reason within one year.While, there was a significant correlation between
osteoporosis and readmission of hip fractures patients for the same reason within one year (P=0.049).
Conclusion: medical complications such as neurovascular and infection in joints are encountered more
frequently than surgical complications such as dislocation of the joint, loosing of the joint and post-operative
disabilities. So, postoperative care is necessary to prevent medical complications.
Keywords:
hip fractures, surgical complications, readmission.

INTRODUCTION

Hip fractures are defined as any fracture of the
to a long-term care facility. About functional
femur between the articular cartilage of the hip
independence, 50% of patients recover pre-fracture
joint to 5 cm below the distal point of the lesser
capability of activities of daily living and 25%
trochanter; they can occur at any age, but they are
recover full capability of their instrumental activities
most common in older persons(1,2).Most patients
of daily living (10).
presenting with hip fracture are women aged over
Hip fractures are classified into three major
50 years and the mean age at first presentation was
types, depending on the specific location of the
approximately 80 years (3,4).
fracture: femoral neck, intertrochanteric and
A worldwide incidence hip fractures were 1.6
subtrochanteric fractures. The term pertrochanteric
million osteoporotic fractures of the hip in people
hip fracture may also be used in hip fracture
aged 50 years and older in 2000, of which about
literature and refers to a more inclusive set of
70% (1.14 million) were in women (5). The absolute
extracapsular fractures, including intertrochanteric,
global annual incidence of hip fracture is expected
subtrochanteric and mixed fracture patterns (11).
to increase to 2.6 million by 2025 and to 4.5
Femoral neck fractures occur in the narrowed
million by 2050 alongside an expanding and
section of the upper femur between the rounded
increasingly elderly population (6,7). Hip fractures
femoral head and bony projections called
are associated with increased mortality; 12% to 17%
trochanters. Femoral neck fractures are grouped
of patients with a hip fracture die within the first
into nondisplaced and displaced fractures by the
year and the long-term increased risk of death was
alignment of the fractured segments about the
two folds (8,9). Of the patients who survive, only one-
original anatomic position of the femur (11).
half walk independently again and 20% must move
215
Received: 1/9/2017 DOI: 10.12816/0043079
Accepted: 11/9/2017

Full Paper (vol.702 paper# 5)


Safety & Efficacy of Intermittent Versus Continuous Anticholinergic Medication in Management of Overactive Bladder in Adult The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 223-227

Safety and Efficacy of Intermittent Versus Continuous Anticholinergic
Medication in Management of Overactive Bladder in Adult
Magdy Fath Alla, Mahmoud Ahmed Mahmoud, Abd El-Rahman Sayed Youssef
Department of Urology, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or
without urge urinary incontinence can considerably impair the patient's quality of life. It is widely
accepted that diet and life style modifications, behavioral therapy and medication belong to the
standard conservative therapeutic options and considered as the first-line measures. The International
Consultation on Incontinence (ICI) guidelines reported that when the first line approach is not fully
satisfactory or fails after 8-12 weeks, alternative therapies should be sought out. It is worthwhile and
justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the
treatment is contraindicated. Second-line of therapies include less-invasive measures such as
percutaneous posterior tibial neve stimulation, sacral neuromodulation, detrusor injections with
botulinum toxin (BTX) and whereas more-invasive measures constitute surgical techniques e.g.
bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today
an established treatment option for patients refractory to or intolerant of conservative treatments.
Objective: this study aimed to compare between the efficacy of continuous anticholinergic therapy
and intermitted anticholinergic therapy for treatment of the overactive bladder.
Patients and Methods: our study included 60 patients categorized into two groups: continuous
anticholinergic therapy group and intermitted anticholinergic therapy. By using 12 weekly intermitted
anticholinergic therapies, remarkable clinical results were obtained. Percent of the patients who complained
OAB in the intermitted anticholinergic group reported a statistically significant subjective success. These
patients chose to continue treatment to maintain the response.
Results:
patients in the intermitted anticholinergic therapy group showed significant improvement of
frequency (31%) urgency (50%) urge incontinence (50%) and nocturia (53%) compared to propiverine
group frequency (50%) urgency (60%) urge incontinence (67%) and nocturia (67%). No serious side effects
were reported, in group A 8 patients had horm of dry mouth in 5 cases (16.7%), constipation in 2 cases
(67%) 8 blurred vision in one case (33%). In group B, there were 5 patients (16.7%) in the horm of dry
mouth in 3 cases (10% constipation in one case (3.3) and blurred vision in one case (3.3%).
Conclusion: our study concluded that intermittent anticholinergic therapy induced improvement of bladder
over activity symptoms and less side effects than continuous anticholinergic group.
Keywords:
bladder outlet obstruction , lower urinary tract symptoms , overactive bladder ,urinary urge incontinence ,
neurogenic detrusor overactivity , detrosor overactivity

INTRODUCTION

Overactive bladder (OAB) refers to a
and heartburn. Of particular concern in the elderly,
complex of urinary symptoms defined by the
is possible cognitive side-effects seen with some
International Continence Society (ICS) as
drugs such as confusion or memory loss which
urgency, with, or without urgency incontinence,
may limit their use. New approaches such as using
usually accompanied by frequency and nocturia
a transdermal route of administration may be
and without proven infection or other obvious
helpful in reducing the side-effects although skin
pathology. The symptom complex is suggestive
irritation can be a problem (2).
of detrusor overactivity, which can be further
Newer second line treatment options
defined as being of unknown cause (idiopathic
included the use of intravesical botulinium toxin,
detrusor overactivity or due to a neurological
sacral nerve stimulation and percutaneous
condition (neurogenic dtrusor overactivity) (1).
posterior tibial nerve stimulation (3).So we
The mainstay of treatment currently is the
conducted a systematic review of the intermittent
use of anticholinergic drugs. Although there has
versus continuous anticholinergic medication in
been considerable development in these drugs over
the treatment of overactive bladder trying to
the last decade, with more bladder specific
minimize the side effects of the medication and
preparations available, many patients even if they
also measure its safety and efficacy in both
find them effective can struggle with side-effects.
groups.
These commonly included dry mouth, constipation
At birth, the bladder stores and
223
Received: 07/10/2017 DOI: 10.12816/0043080
Accepted: 17/10/2017

Full Paper (vol.702 paper# 6)


c:\work\Jor\vol702_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 228-233

Short Stature in Children
Nouf Awad Saleh Albalawi1, Badriah Abdulrahman Basheer Alsabah1,
Ahmed Yaseen Alrefaei2, Areej Mohammed Saad Alatawi1, Maha Salem Albalawi1,
Zainab Metaeb Mohammed Monaked Al-Enazi1, Mashael Zayed M Albalawi1,
Ashwag Ahmed M Alshehri1, Wejdan Abdulrahman Ali Alqarni1

1 Prince Salman Armed Forces Hospital, 2Tabuk University.
ABSTRACT
Short stature is a common problem in children. Short stature occurred due to many causes; these causes
may be genetic, environmental or chronic diseases. Diagnosis of short stature could be achieved by two
combined ways, physical examination, and laboratory tests. Treatment of short stature depends on the right
diagnoses and the causative agent.
Keywords: Short stature, Growth Hormone, children diseases.

INTRODUCTION


The general health of children can be
Short stature is common in children, and it is a
monitored by growth which is an important
result of poor linear growth (8). Short stature
parameter (1). It is a continuous biologic process
statistically is known as children who are shorter
that depends on many factors including nutrition
than 97% of their age and gender-matched peers
and hormone status (2). Monitoring of growth in
(9). Persons whose height is below the third
children is a part of preventive child health
percentile for age and sex, or more than two
programs (3). The monitoring of normal growth can
standard deviations below the mean are considered
be performed by growth charts (4). Abnormal
as suffering short stature (4). Short stature can be
growth may refer to the presence of underlying
defined by using velocity chart, if the growth
disease in the apparently normal child. Early
velocity of a child is less than 25th percentile
detection and diagnosis of short stature decrease
below the mean for that age, short stature will be
the effect of any underlying health condition and
considered. The height of the child can be
optimizes final adult height (5). Short stature (SS) is
interpreted by family's genetic potential for
a problem in children globally (2) and especially in
growth, in boys' mid-parental height = (father +
developing countries (6). Short stature may be
mother +13)/2, while in girls= (father -13+
caused by many reasons related to the endocrine
mother)/2]. The mid-parental height value is
system, nutritional status, and genetic causes (1).
plotted as the adult height at 18 years and spread 6
Short stature is considered as a sign of poor health
cm on another side of the target height; the
in childhood (3). It is unrecognized in early infancy
children height is considered to be normal when
that's why it is diagnosed at a late age which
the height is with within this percentile (10).The
affects the improvement on health outcomes and
children whose height below the third percentile
stature (7).
known as the lower limit of normal, most of them
are healthy, however many of them will attain
METHODS
Review articles and research articles between
normal stature as adults (11), so the most common
the year 1990 and 2016 were collected using
reason for referring to a pediatric endocrinologist
different electronic databases such as PubMed and
is Short stature in childhood (12). Most of the
Google Scholar. Also, information was collected
children whose height below the lower 2.5
from Centers for Disease Control to identify the
percentile but with normal growth pattern is
different definitions of short stature, its
considered normal, however, those below 2.5
prevalence, its causes as well as management of
percentile an individual's \growth are thought to
short stature. Different keywords were used in the
have a pathological condition keeping them from
searching process, the title of each article was
achieving their genetically determined height
checked, and Articles which were not relevant
potential (5). The first step to prevent short stature
have been rejected. Articles have been reviewed
is to know its prevalence and its complications (8).
and collection of information has been done.
The prevalence of Short stature differs worldwide
(13)
The study was approved by the Ethics Board of
, the highest prevalence was reported in
Tabuk University.
Bangladesh to be 73.6 % in 1991 (14). Almost 2.2
million children under age 18 have heights below

the third percentile in United States (15), although
DISCUSSION
most of them are healthy, minor of them have
1. Short stature definition and prevalence
The height of child results from the initial
pathologic etiology for short stature (16). Australia
length at birth and the rate of growth over time (5).
was the lowest in prevalence where the percent of
228
Received: 21/9/2017 DO I: 10.12816/0043081
Accepted: 30/9/2017

Full Paper (vol.702 paper# 7)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 234-238

Major Changes in Urine Investigations after Orthotopic Cystectomy
with Ileal Neobladder
Hany Hamed Gad Hasan, Mohamed Ibrahim Ahmed Ibrahim,
and Saad Khalid Abdulkareem Almulay
Department of Urology, Faculty of Medicine, Ain Shams University
Corresponding author: Saad Khalid, email: dr.saadkhalid@gmail.com
ABSTRACT
Background:
urinary and metabolic changes differ in their severity and consequences. The severity of these
changes is directly related to the type of bowel segment, surface area of bowel used, duration of urine storage
concentration of solutes in urine, urinary PH and osmolarity, medications and underlying renal and hepatic
function of the host. Aim of the work: this study aimed to characterize the physical, chemical and biological
characters of urine in patients who underwent radical cystectomy with ileal neobladder and these could be
utilized as a nomogram to which urine disorders in diversion patients were compared.
Design: this was a retrospective cohort.
Patients and Methods: this study was a prospective cohort and it included 150 patients and it was carried out in
outpatient Clinic of Urology and Oncology Centers. 100 patients had radical cystectomy and ileal neobladder at
least 6 months before the study. 50 of them were on alkaline treatment, the rest 50 were not. The last 50 were
served as the control group. Also, all the patients had signed consent for taking their information in this study.
Results: this study included 150 patients who underwent radical cystectomy and ileal neobladder. The mean age
+ Sd was 59.8 + 9.5 and for the control group was 47.6 + 8.7 with no significant difference (p value 0.08). No
significant difference was detected between both diversion groups as regard demographics (including sex) and
follow up period except taking oral urine alkalinizers.
Conclusion: the urine excreted from diverted patients differed from those with normal bladder and this would be
of real importance to announce and increase the awareness among the treating physicians including the general
practitioners, the urologists and other health providers. They have to know that those patients do not have a
classic urinary bladder that is to say their urine is not real urine representing the urinary tract and this may avoid
a lot of unnecessary procedures or to protect such group of patients from unrecognized clinical and medical
mistakes.
Keywords: orthotopic cystectomy, ileal neobladder, orthotopic bladder substitution.

INTRODUCTION

After orthotopic cystectomy, the urinary
both the urine composition and serum (3).Urinary
diversion must be done. Variety of options had
and metabolic changes differ in their severity and
been suggested for the usage of the intestine such
consequences. The severity of these changes is
as: urinary conduits, ureterosigmoidostomy,
directly related to the type of bowel segment,
orthotopic bladder substitution (OBS), continent
surface area of bowel used, duration of urine
cutaneous diversion (1). Colon has less compliance
storage concentration of solutes in urine, urinary
than ileum, which in turn has lower contractility
PH and osmolarity, medications and underlying
with minimum metabolic complications (as far as
renal and hepatic function of the host (4).
Vit. B12 deficiency and megaloplastic anemia) so it

has the upper hand in the favoritism of the
PATIENTS AND METHODS
urologists (2). Bowel segment differs from relative
This study was prospective cohort and it
urothelium, exposure of bowel segment to the urine
included 150 patients and carried out in outpatient
results in exchange of water and solutes across
clinic of Urology and Oncology Centers, 100 of the
intestinal mucosa due to its absorptive and secreting
patient had radical cystectomy and ileal neobladder
properties. This mechanism may alter the volume
at least 6 months before the study: 50 of them were
and composition of the urine when stored in the
on alkaline treatment, the rest 50 were not. The last
reservoir for a time. These urinary changes result in
50 served as the control group. Also, all the patients
multiple short and long term sequels and changes in
had signed consent for taking their information in

the study.
234
Received: 08/9/2017 DOI: 10.12816/0043082
Accepted: 17/9/2017

Full Paper (vol.702 paper# 8)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 239-244

Percutaneous Nephrolithotomy Versus Non-Stented Extracorporeal Shock
Wave Lithotripsy for Medium Sized Kidney Stones
Shereein Ibrahim Ragy, Diaa El Din Mahmmoud Abdel Fattah
Mohammed Abdel Fattah Abdel Khalek Shalaby
* Department of Urology, Faculty of Medicine, Ain Shams University

ABSTRACT
Background:
nephrolithiasis is a common complex disease. It is the third most common disaster of the
urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. About 50
% of recurrent stone formers have just one life time recurrence. At present, the great expansion in
minimally invasive techniques has led to the decrease in open stone surgery (OSS). Extracorporeal shock
wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the
kidney and upper urinary tract through the use of shock waves (SWs). Nevertheless, as there are limitations
with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous
nephrolithotomy (PNL) are considered.
Aim of the work: this study aimed to evaluate the effectiveness of ESWL VS PNL in management of non-
lower polar medium sized stone (1-2 cm) as regards to stone size, location and number.
Patients and Methods: this is a prospective randomized comparative clinical study that was conducted in
Ain Shams Urology Department and Agouza Hospital Urology Department from December 2016 till
September 2017.Sixty patients were enrolled; of which 30 patients underwent PNL and other 30 patients
underwent Non-stented ESWL complaining of non-lower polar medium sized calyceal stones (1-2 cm). All
patients were categorized into two subgroups; group A for ESWL and group B for PNL. Patients with
lower calyceal stones, stone burden more than 2 cm, recurrent kidney stones, renal impairment, pregnant
women and children were excluded from this study. Our study included 45 males (75%) and 15 females
(25%) with a mean SD age 43.7812.68 years (range 25 to 65). The patients' criteria (age, sex, body mass
index) and the stone characteristics (side, stone size, attenuation value and skin- to-stone distance) were
compared between both groups. The SFR rate, the need for secondary procedures were calculated and
compared.
Results: 30 patients underwent PNL and the other 30 patients underwent Non-Stented ESWL. Twenty nine
patients (96.6%) who underwent PNL rendered SFR detected by Non-enhanced Helical CT (Less than 4
mm) after one month; two cases 2 mm and 3 mm CIRF and only one case with 4 mm residual whereas only
5 patients (16.7%) in the ESWL group with high significance (P < 0.001) and all patients in PNL group
were completed stone clearance without auxiliary procedure (p< 0.001).
Conclusion: PNL is the modality of choice in medium sized (1-2cm) lower calyceal renal stone. PNL was
more effective than ESWL for treating medium sized (1-2 cm) non lower polar renal stone, it has
advantages of higher initial SFR with short time of treatment and lower auxiliary procedures (lower
retreatment rate).However, ESWL was associated with fewer complications.
Keywords: extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), stone-
free rate (SFR).

INTRODUCTION


Nephrolithiasis is a common complex
(pregnancy, mid and lower ureteral stones in
disease.it is the third most common disaster of the
women of child bearing age) [2, 3, 4].
urinary tract, exceeded only by urinary tract
AUA and EUA 2015 guidelines
infections and pathologic conditions of the
committees for the management of renal calculi
prostate. About 50 % of recurrent stone formers
considered ESWL and endourological procedures
have just one life time recurrence [1].
as equivalent first-line therapy for the treatment of
Currently, ESWL is indicated for most
most urinary stones independent of location or
uncomplicated upper urinary tract calculi, that is,
type and for size equal or less than two
an aggregate stone burden of <2 cm in kidneys
centimeters though as stone burden increases SFR
with normal renal anatomy. Shock wave
for ESWL decreases [5].
lithotripsy is also considered as an appropriate
ESWL with PNL indicated as a sandwich
alternative for the management of ureteral stones
therapy for staghorn stones and start with ESWL
anywhere in the ureter with a few caveats
with total SFR about 66 % [6].
239
Received: 05/10/2017 DOI: 10.12816/0043083
Accepted: 15/10/2017

Full Paper (vol.702 paper# 9)


c:\work\Jor\vol702_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 245-250

Association between Bronchial Asthma and Pubertal Delay in
Pediatric Patients
Abdullah Khalid A Dakhel, Fahad Abdullah R Alqeaid , Fahad Mohammed A Alkhuzayyim
Qassim College of Medicine

ABSTRACT

Background: asthma is a chronic inflammatory disease with a considerable prevalence and
unfavorable impacts on various body systems. The natural history of asthma has been extensively
investigated in terms of the varied effects on age and gender. Aim of the study: this study aims to achieve
a better understanding of the unclear relationship between bronchial asthma and pubertal delay in the
pediatric age group. Methods: we reviewed the scientific literature concerned with studying the effect of
asthma and its treatment on the growth of children and the onset of puberty using some international
medical databases (Medline, Google scholar, EMBASE). Conclusion: Although there have been some
community-based surveys and studies based on young children which failed to find an association between
asthma and growth, others revealed that asthma can cause growth retardation through different
mechanisms, including hypoxia, impaired lung functions, or endocrine malfunctions. Pubertal delay is also
observed in untreated asthmatic boys and girls. In addition, inhaled corticosteroids, the best available
treatment of asthma, were found also to have an effect on pubertal delay and this effect is dependent on the
dose, duration and the outcome of therapy. When concentrating on pubertal delay, it seems that more
longitudinal studies are required to comprehensively investigate the effects of asthma and its treatment on
this vital stage of life.
Keywords: asthma, puberty, delayed puberty, pediatric growth.

INTRODUCTION

Being one of the commonest disorders of
development, with males having a tendency to
childhood, bronchial asthma has been acquiring the
develop asthma while females would have a
attention of medical researchers as it produces
subsequent relative deterioration in lung function ,
severe symptoms enough to be a real threatening
such findings were evidenced by studies observing
condition. The prevalence of childhood asthma has
multiple changes in asthma taking place with the
been increasingly reported over the last three
fluctuations of sexual steroid hormones observed
decades in developed countries, however, it has
during pubertal development until complete
been reported that the prevalence decreased in
maturity (4). Considering the overall growth pattern
adolescents in Western countries (1). Setting an
during childhood up to the age of puberty, there
accurate definition of asthma is apparently difficult
have been many conflicting perspectives
particularly in infants. For older children, a clear
concerning the effects of asthma on growth. In this
definition can be established for asthma as an
review, it is now our opportunity to demonstrate
airway inflammation with airflow limitation
the relevant literature related to the relationship
leading to suffering from cough and wheezes. In
between asthma severity and its therapeutic
such cases, there is a predominance of eosinophils
approaches and their impact on the growth and
and mast cells with an association of an increased
developmental processes as well as the possible
responsiveness of bronchi (2).
consequences leading to a pubertal delay.
The actual mechanism by which the
The study was done according to the
development of airway inflammation takes place in
ethical board of King Abdulaziz university.
asthma has been well documented (3). Several steps

are involved starting initially with a primary An overview of delayed puberty
sensitization followed by the occurrence of an
Considering both sex and ethnic origin of an
immune response of allergic phenotype. The
individual, the puberty can be delayed when there
sensitized cells can be subsequently activated by
is a lack of normal pubertal development at an age
the following exposures resulting in releasing
of 2 SD above the mean age, which could be
inflammatory mediators.
observed in boys at an age of 14 years with a
The natural history of bronchial asthma has
testicular volume less than 4 ml and in girls at 13
been extensively investigated in terms of the varied
years of age with a lack of the larche. Generally,
effects on age and gender. Furthermore, it has been
the proposed cutoffs for the puberty age could be
noticed that there is an apparent sexual variation in
between 10 and 16 years of age (5). The chief causes
children with asthma and their respiratory system
of pubertal delay are broadly classified as genetic
245
Received: 10/10/2017 DOI: 10.12816/0043084
Accepted: 20/10/2017

Full Paper (vol.702 paper# 10)


c:\work\Jor\vol702_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 251-256

Knowledge and Attitudes of Parents on Childhood
Immunization in Riyadh, Saudi Arabia
Esra Saleh ALAmri, Youssef Fayez Horaib, Wala Rafa Alanazi*
Almaarefa Colleges, Riyadh, Saudi Arabia.
*Corresponding author: Wala Rafa Alanazi, Email: Wala.r.alenezi@gmail.com, Mobile number: +966506120311

ABSTRACT
Background
: this study aimed to assess parental knowledge and attitudes on childhood immunization among
Saudi parents.
Methods: this was a cross sectional prospective study. Pretested well designed questionnaires were distributed
during March 2017. Parents with children of 0-12 years old were invited to answer the questionnaires.
Association between dependent variables (knowledge, and attitudes) and independent ones (parent's
demographics) were tested using Chi-square test. P values of < 0.05 were considered statistically significant.
Results: a total of 731 parents were recruited. Parents had good knowledge on aspects related to the general role
of vaccination in prevention of some infectious diseases were 672(91.9%), timing of the first dose in vaccination
schedule included 635(86.9%). However, poor knowledge was documented among parents in other aspects like
the importance of administration of multiple doses of the same vaccine to child immunity were 304(41.6%),
administration of multiple vaccines at the same time have no negative impacts on child immunity were
271(37.1%), vaccination of children against seasonal influenza were 334(45.7%) and contraindication to
vaccination were 287(39.3%). Parents attitudes towards immunization was positive expect in some aspects
related to vaccination side effects showed 316 (34.2%) and the probability of occurrence of diseases against
which the child was vaccinated was 288(39.4%). Gender, residence and educational level were found to be
significantly associated with both parent's knowledge and attitudes towards immunization.
Conclusion: although parents had good knowledge and positive attitudes on some aspects related childhood
immunization, gaps in both studied domains were identified. Educational interventions are needed to upgrade
parent's knowledge with special emphasis on less educated and residents of rural areas.
Keywords: parents, knowledge, attitude, childhood immunization

INTRODUCTION

Immunization has greatly reduced the burden of
Greater concern about the safety of vaccines
infectious diseases (1). Immunization prevents illness,
was expressed by older parents, residents of towns
disability and death from vaccine-preventable
and highly educated individuals (7). On the other
diseases including diphtheria, measles, pertussis,
hand, researchers in developed world found parent's
pneumonia, polio, rotavirus diarrhoea, rubella and
attitudes and beliefs had little effect on their
tetanus (2). Paren's knowledge about immunization
children's immunization levels (8). Despite the fact
and their attitudes towards them are likely influence
that local and systemic reactions to vaccines are
uptake (3). Previous studies revealed misconceptions
identified (9), but they were found to be one of the
on parent's knowledge and negative attitudes
barriers to childhood immunization among other
towards
childhood
immunization.
Mother's
factors(10).
knowledge about vaccination was found to be quite
Increased number of parents are questioning the
low and their educational status was significantly
safety and necessity of routine childhood
associated with child's coverage (4).
immunizations. The belief that vaccines cause
Negative attitude, for example mothers fear from
autism was the most prevalent parental concern in a
vaccination was found to be significantly affected
survey conducted in USA (11). Although researches
the immunization status of their children
have been published on parent's knowledge,
(5).Zagminas et al. (6) assessed parent's knowledge on
attitudes and practices regarding childhood
immunization and noted that most of the respondents
vaccination no such studies have been reported in
had a positive opinion about vaccination, although
Saudi Arabia. Therefore, this study was undertaken
20-40% of respondents indicated insufficient
to assess parental knowledge and attitudes on
knowledge on this issue.
childhood immunization among Saudi parents.


251
Received: 10/10/2017 DOI: 10.12816/0043085
Accepted: 20/10/2017

Full Paper (vol.702 paper# 11)


c:\work\Jor\vol702_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 257-264
Prevalence of Respiratory Distress Syndrome in Neonates
Shahad Abdulhafith Qari11, Areej Abdulrhman Alsufyani1, Sharaf Hassan Muathin 2,
Nesriene M. El Margoushy
1.Medicine Department, College of Medicine, Taif University, 2.NICU Department, College of Medicine, Taif
University King Abdulaziz Hospital, Taif, Saudi Arabia

ABSTRACT
Background:
Acute respiratory distress syndrome is defined as acute diffuse inflammatory lung injury causing
increased pulmonary vascular permeability with increased lung weight, loss of aerated lung tissues leading to
hypoxemia and bilateral radiographic opacities associated with increased venous admixture, increased
physiological dead space and decreased lung compliance. Aim of work: to determine the prevalence rates of
respiratory distress syndrome (RDS) in neonates in King Abdulaziz Hospital, Taif city, Saudi Arabia and to find
out the most important causes of RDS in preterm babies in Taif city. Methods: a cross-sectional questionnaire
based study carried out in Saudi Arabia, Taif city, King Abdulaziz Hospital from January to June 2016 (6 months
period) on preterm neonates. Results: 57.1% of newborn were male gender and 42.9% were female, 4.4% of
babies were extreme preterm, 86.5% were preterm, 4.4% were late preterm and 4.7% were full term, the
prevalence rate of RDS in newborn was 54.7% in the 6 months of this study. Conclusion: RDS is one of the
major problems among newborns and a major reason for increased morbidity and mortality among infants.
Preterm babies are the main risk factor for development of RDS. Mother's illnesses, especially hypertension and
Diabetes are very strong risk factors for the disease in preterm babies. Cesarean delivery, especially in preterm
babies and male gender stays other important risk factors for RDS.
Keywords: Respiratory Distress Syndrome , Neonates,SA.

INTRODUCTION
first 48 hours with transient tachypnea of the
Berlin definition of acute respiratory distress
newborn, infections, meconium aspiration syndrome,
syndrome (ARDS) is the recent definition, it defines
hyaline membrane disease (HMD) and perinatal
ARDS as acute diffuse inflammatory lung injury
asphyxia [3]. The incidence of ARDS ranges from 1.5
causing increased pulmonary vascular permeability
cases per 100000[4] to nearly 79 cases per 100000[5]
with increased lung weight, loss of aerated lung
with European countries reporting a lower incidence
tissues leading to hypoxemia and bilateral
than USA [6].Understanding the incidence of ARDS is
radiographic opacities associated with increased
important because of the costly medical care and high
venous admixture, increased physiological dead space
mortality rate associated with the disease. Since there
and decreased lung compliance[1]. Acute respiratory
were limited studies about the prevalence of the acute
disease is the leading cause for hospitalization in
respiratory distress syndrome in neonates in Saudi
neonatal intensive care units. RDS considered to be
Arabia, the purpose of this paper is to examine the
the major reason for increased mortality and
prevalence of acute respiratory distress syndrome in
morbidity among infants. Neonatal respiratory
neonates in Saudi Arabia. Hopefully, this report will
distress syndrome (RDS) occurs in infants whose
increase awareness of respiratory distress syndrome
lungs have not yet fully developed. It can also be due
in Saudi Arabia. The given results will guide clinical
to genetic problems with lung development. Most
decision and improve the outcomes. Treatment for
cases of RDS occur in babies born before 37 to 39
respiratory distress syndrome (RDS) usually begins
weeks. The more premature the baby is, the higher
as soon as an infant is born, sometimes in the delivery
the chance of RDS after birth. The problem is
room. Most infants who show signs of RDS are
uncommon in babies born full-term (after 39 weeks)
quickly moved to a neonatal intensive care unit
[2]. Respiratory distress syndrome (RDS) is diagnosed
(NICU). The most important treatments for RDS
by the presence of at least two of the following
include: surfactant replacement therapy, breathing
clinical signs: tachypnea (>60/min), dyspnea with
support from a ventilator or nasal continuous positive
inspiratory subcostal or intercostal retractions, nasal
airway pressure (NCPAP) machine which makes
flaring, expiratory grunting and cyanosis in room air.
premature infants breathe better and oxygen therapy.
Most frequently diagnosis of RDS occurs during the
Antibiotics may be given to infants to control

infection. Supportive therapy for infants is carried out
257
Received: 10/10/2017 DOI: 10.12816/0043086
Accepted: 20/10/2017

Full Paper (vol.702 paper# 12)


c:\work\Jor\vol702_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 265-272

Maternal Awareness and Attitude about Neonatal Screening
Program in the Eastern Region of the Kingdom of Saudi Arabia
Fadhel Mohammed Alfayez1, Mohammed Ahmed Alamir2, Hassan Ali Alnahwi2,
Dhiyaa Mohammed Aleid2, Hawra Jaafar Alsheef3, Mujtaba Jameel Alzakari4,
Anwar Ramadan Alhamad5, Anas Said Badghaish4
1College of Medicine, Najran University, Najran, KSA, 2Medical University of Warsaw, Warsaw, Poland,
3King Khalid University, Abha, KSA, 4Imam Abdulrahman Bin Faisal University, Dammam, KSA,
5Maternal and Children Hospital, Alhasa, KSA

ABSTRACT
Background:
despite the worldwide recognition of the importance of pre-screening education of parents, the
current body of evidence suggests that parents often receive little information about neonatal screening (NS)
and may even be unaware about the screening of their baby.
Aim of the work: this study aimed to assess the attitudes and knowledge of the Saudi women towards the NS
program and their psychological impact.
Methods: we performed a cross-sectional study on mothers in the Eastern Region of the Kingdom of Saudi
Arabia. A modified version of the Maternal Attitudes and Knowledge about Newborn Screening Survey was
used to assess the attitudes and knowledge of the women towards the NS program.
Results: we retrieved 388 surveys. Twenty-five percent of the women acquired their knowledge about NS
programs from the internet. Eighty-two percent of the women had healthy children and 42% of them think that
the best time to know about NS programs is at the time of screening itself. Our analysis showed a significant
association between the educational level and knowledge about the best time to learn about neonatal screening
(p=0.0001). Almost half of the women who had one child stated that the screening should take place 2-3 months
before the baby is born (p=0.018). The child health status was also associated with the knowledge that if the
baby's newborn test is abnormal I might have something wrong with my DNA (p=0.015). It was also associated
with knowing that NS will test for common diseases that run in families like diabetes, asthma and heart disease
(p=0.02). Conclusion: Saudi women had a positive attitude, but with little knowledge towards the NS program.
Further studies are needed to assess the predictors of different levels of knowledge.
Keywords: neonates; knowledge; attitude; public health awareness.

INTRODUCTION

proposed to be linked with less psychological
Neonatal screening is defined as the mass
harms associated with false-positive results(5).
blood-spot screening that aims at early detection of
Despite the worldwide recognition of the
rare congenital disorders. This early detection and
importance of pre-screening education of parents,
the following immediate treatment may improve
the current body of evidence suggested that parents
the prognosis of such rare, but treatable
often receive little information about NS and may
conditions(1). Over the past decades, NS has been
even be unaware about the screening of their
recognized as a valuable component of neonatal
baby(1).Regarding the Middle East, NS programs
care in many developed countries around the
have been recently implemented. A study from Iraq
world(2). Both national and international efforts are
reported that mother's awareness towards NS was
currently conducted to implement it as a major
low, but their attitudes towards NS tests were
public health program, which requires a proper pre-
positive(6). In Saudi Arabia, NS programs were
screening education for parents(3).
offered for 16 known biochemical and endocrine
Informing parents about the benefits and
genetic disorders since 2005. According to a recent
process of screening is associated with more
report, Saudi women had a positive attitude towards
positive response to the requests of additional
the NS program. However, they had several
testing(4). In addition, proper knowledge about the
concerns to improve the availability of medication
possibility of errors in the initial NS has been
and formulas, education materials and awareness(7).

However, Al-Sulaimanet al. (7) remained the only

study that assessed NS awareness among the Saudi
265
Received: 9/10/2017 DOI: 10.12816/0043087
Accepted: 19/10/2017

Full Paper (vol.702 paper# 13)


c:\work\Jor\vol702_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 273-281

Serum Copper and Zinc levels in Vitiligo Patients
Marwa A. Salem, Talal A. Abd El-Raheem, Nesreen M. Aboraia
Department of Dermatology STDs and Andrology
Faculty of Medicine, Fayoum University
Corresponding author: Marwa A Salem, Mobile: 01005264296; Email: nobel79@yahoo.com

ABSTRACT
Background:
vitiligo is a common, acquired, discoloration of the skin, characterized by well circumscribed,
ivory or chalky white macules and patches. Researchers suggested that vitiligo may arise from autoimmune
(AI), genetic, oxidative stress or neural causes. Zinc (Zn) and copper (Cu) are trace elements that are required
in minutely small doses. The unique process of keratinization and melanin formation is enzyme-dependent
and therefore could be influenced by trace elements deficiencies or excesses as trace elements are involved in
enzymatic activities and immunologic reactions. Aim of work: this study aimed to detect the levels and roles
of serum Zn and Cu in the pathogenesis of vitiligo. Patients and methods: our study included 50 vitiligo
patients and 50 apparently healthy controls. Age of study groups ranged from 15 to 60 years and both sexes.
Serum Zn and Cu levels were measured in each study group. Results: serum Zn levels were statistically
significant lower in both the studied groups, but in vitiligo group they were much lower than the control
group. Serum Cu levels were statistically insignificant higher in vitiligo group than the control group.
Conclusion:
there is a relationship between vitiligo and serum Zn. Further studies are needed to obtain better
knowledge about effect of the trace elements in vitiligo patients.
Keywords: vitiligo, serum Zn, serum Cu.

INTRODUCTION

Vitiligo vulgaris is defined as an
and Cu levels in vitiligo patients and their relation
idiopathic,
acquired
type
of
leukoderma
to the etiopathogenesis of vitiligo.
manifested by depigmentation of the epidermis

resulting from destruction of melanocytes (1).
PATIENTS AND METHODS
Researchers suggested that vitiligo may arise from
Patients
autoimmune (AI), genetic, oxidative stress (OS) or
The present study was conducted on 50
neural causes (2). It is believed that AI etiology is
vitiligo patients and on 50 healthy controls. Serum
the most plausible factor (3).
Zn and Cu levels was measured in both groups.
The global incidence of vitiligo is less than
Patients were selected from the attendants of
1% (4), with some populations averaging between
outpatient clinic, Department of Dermatology,
2-3% and as high as 16% (5). Vitiligo is classified
STDs and Andrology, Faculty of Medicine,
into segmental vitiligo (SV) and non-segmental
Fayoum University and ETSA Govermental
vitiligo (NSV). NSV is the most common type.
Hospital in the period from 1/3/2015 to 1/10/2015.
There is no cure for vitiligo, but several treatment
Written consent was obtained from every
options are available (6). Conventional treatments
individual. Approval was obtained from the
for vitiligo included photochemotherapy (psoralen
Ethical Committee of Human Rights in Research
plus ultra-violet A) (PUVA), phototherapy (UVB),
of Fayoum University before study initiation.
vitamin D3 analogues, topical corticosteroids

(TCS), topical immunomodulators, excimer laser
Inclusion criteria
and surgery. These treatment options have limited
Vitiligo patients
success (7). The best evidence is for
All types of vitiligo
applied steroids and the combination of UV
Both sexes
light in combination with creams (8).
Age from 15 to 60 years
Zinc (Zn) and copper (Cu) are two of the
Exclusion criteria
trace elements that found in small amounts in the
Presence of leukoderma secondary to other causes.
body (9). Zn and Cu are involved in many
History of other obvious skin diseases.
homeostatic mechanisms of the body, such as
Undergoing treatment with zinc or any history of
specific immunity, inflammation and oxidative stress
zinc intake for 6 weeks before this study. Suffering
(OS) (10). Decreased serum Zn and Cu levels have
from any other systemic diseases such as: hepatic
been reported in vitiligo by some investigators (11),
cirrhosis, viral hepatitis, neoplastic condition,
while others contradicted these findings (11).
myocardial infarction, steatorrhea, or renal failure,
Aim of study: this study aimed to detect the
pregnancy or consumption of oral contraceptive
possible changes in the metabolism of serum Zn
273
Received: 3/10/2017 DOI: 10.12816/0043088
Accepted: 13/10/2017

Full Paper (vol.702 paper# 14)


c:\work\Jor\vol702_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 282-286
Renal Involvement in Cases of Spindle Epithelial Tumor with Thymus-Like
Differentiation: A Case Report and Review of the Literature
Ahmed N Khogeer1, Salman H Felemban1, Hatim Maghraby2, Intisar Rasheedy2,
Salahudin Lamy2, Hasan AlMadani2
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi
Arabia, 2 King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia

ABSTRACT
Background:
Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare neoplasm of
the thyroid first described by Chan and Rosai in 1991. Renal involvement usually occurs as part of a
disseminated metastatic picture. SETTLE is believed to arise from branchial pouch or thymic remnants and
shows primitive thymic differentiation.
Presentation:
A 41-year-old male presented with a thyroid mass in 2005. The patient underwent a total
thyroidectomy followed by radiation therapy. Pathology concluded papillary thyroid cancer. In 2011, the
patient was admitted with worsening cough. CT showed lung involvement, multiple mediastinal lymph nodes,
and a left renal mass. A biopsy established the diagnosis of SETTLE. Four cycles of platinum chemotherapy
were given. In 2014, the patient was referred to Urology with progressive flank pain and hematuria. CT
showed a progression of the renal mass, and results of an U/S guided biopsy of the kidney were consistent
with SETTLE. An elective radical nephrectomy was performed in late 2016 to relieve symptoms. The patient
is currently being followed as an outpatient.
Conclusion:
Due to the rare nature of SETTLE, algorithms for the diagnosis, treatment, and outcomes are not
established. Although SETTLE presents as a low-grade malignancy, this case, as well as other reported cases
with a long follow-up duration, suggested that it can metastasize many years after initial diagnosis. More data
is needed to elucidate the risk and prognosis of renal metastasis in SETTLE.
Keywords:
SETTLE, spindle epithelial tumor with thymus-like differentiation.

INTRODUCTION

register case studies that report renal involvement,
Spindle Epithelial Tumor with Thymus-
thus registering the prevalence of such implication
Like Differentiation (SETTLE) is a remarkably rare
as a result of this disease. It is also our aim to
tumor of the thyroid gland less than 50 clinical
pinpoint any drawbacks and limitations observed in
cases - that was first observed and described by
these case reports such as lack of adequate follow-
Chan and Rosai in 1991 (1). SETTLE is believed to
up time, or even loss of follow-up.
arise from branchial pouch or thymic remnants, and
Our second objective is to present our experience
it displays primitive thymic differentiation (2). It is
with our case, which was referred to Urology with
mostly a disease of the younger population (an
progressive flank pain and haematuria. Our case is a
average of 18 years old) and can lead to the
follow up on a case reported by Recondo et al. (8).
development of delayed blood-borne diseases and
We specifically want to outline how alternative
metastases to lymph nodes, lungs, pancreas, and
management earlier in the course of the disease
kidneys (3). Kidney involvement is usually part of a
could have resulted in a different outcome.
disseminated metastatic picture. Initial diagnosis of
Systematic review of the literature
this disease is challenging due to the lack of specific
Systematic
literature
reviews
are,
signs and symptoms.
practically, key parameters of public health, nursing,
Histologically, SETTLE's predominant feature
and evidence-based healthcare because they can
involves a low-grade biphasic tumor with metastatic
provide results and conclusions that rely on and
potential that is characterized by low mitotic
verify - a previously formulated question.
activity, rare focal necrosis and with usually

indolent growth. It is characterized by fascicles of A) METHODOLOGY
spindle cells intermingled with tubulopapillary
As defined in PRISMA guidelines, there is a
structures (4).
need in applying specific eligibility criteria that will
Research aims and objectives
guide researcher's decision on study inclusion into
Our first objective is to perform a
this analysis. A retrieved article/source will only be
systematic literature review on the topic of
eligible for inclusion if the respective source reports
SETTLE, emphasizing on case reports available in
either primary or secondary research and follows a
the literature. We especially want to distinguish and
valid research methodology such as RCT, cohort
282
Received: 10/10/2017 DOI: 10.12816/0043089
Accepted: 20/10/2017

Full Paper (vol.702 paper# 15)


c:\work\Jor\vol702_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 287-288

Multiple Types of Coloboma in an Otherwise Healthy Patient: A Case Report
Ayman A Alghamdi1, Musab A Alsubaie1, Ahmed N Khogeer1, Mohammed Malak2
1 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, 2
Department of Ophthalmology, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
Corresponding author: Ayman Abouras, E-mail: ayman.abouras@gmail.com

ABSTRACT
Purpose:
this study aimed to report a case of a unilateral lenticular coloboma super imposed over bilateral iris
and optic nerve coloboma in a healthy patient, colobomas are rare congenital malformation of the neuro-
ectodermal tissue of the optic cup. Materials and Methods: this case of medically free patient who
complained of poor vision since early childhood that has progressed in the last five years. Patient underwent
thorough and complete ophthalmic investigation. Results: fundus photography revealed inferior optic nerve
colobomas in both eyes and no uveal colobomas. On slit lamp examination, bilateral inferior iris coloboma
were noted. Systemic examination was unremarkable. Patient was otherwise healthy. Conclusion: our report
showed the need of more studies to be done in order to have a better understanding of the prevalence,
management and genetics related to this condition in our population.
Keywords:
optic nerve coloboma, iris coloboma, optic nerve malformation, optic nerve anomaly.

INTRODUCTION

medical evaluation. The patient complained of poor
Colobomas
are
a
rare
congenital
vision since early childhood that has progressed in
malformation of the neuroectodermal tissue of the
the last five years. The patient was suffering from
optic cup. Typically, during the 7th week of
occasional photophobia. Family ocular history was
gestation, the optic cup is formed by the closure of
positive: The patient's brother was suffered from
the choroidal fissure, leaving a round opening that
decreased vision since childhood as well he did not
becomes the pupil. Failure of this process results in a
seek any medical advice. Distant unaided visual
persistent cleft that can involve the anterior or
acuity (VA) was 6/18, 6/60, and best-corrected
posterior parts of the eyeball (1). Coloboma iridis
visual acuity (BCVA) was 6/12 and 6/21 for the
where the malformation occurs anteriorly and is
right and left eyes respectively. The patient had no
limited to the iris - is the most common form.
nystagmus or strabismus and intraocular pressure
Anterior colobomas may also involve the ciliary
(IOP) was normal in both eyes. On slit lamp
body. Posterior colobomas may involve the optic
examination (SLE), the eyelids, conjunctiva and
nerve, retina and choroid (2). It is estimated that the
cornea were normal bilaterally. The anterior
incidence of coloboma is around 0.7 cases per
chambers of both eyes were deep and quiet. A
10,000 live births. Although colobomas are not
bilateral inferior iris coloboma was noted.
usually familial, they have been observed to be
Additionally, developmental cataracts that are not
occasionally inherited in an autosomal recessive or,
visually significant were noted in both eyes, as well
rarely, an X-linked pattern. Colobomas may also be
as an inferior lenticular coloboma in the left eye. On
associated with a with PAX2 gene mutations (2,3).
fundus examination, there were inferior optic nerve
CASE
colobomas in both eyes and no uveal colobomas
Our case was a 36-year-old medically free
(Fig.1 A,B). Systemic examination showed no
male referred to our hospital from another city for
abnormalities or apparent congenital anomalies.





Figure 1A, B: right and left eye, respectively, showing inferior optic nerve coloboma.
287
Received: 13/9/2017 DOI: 10.12816/0043090
Accepted: 22/9/2017

Full Paper (vol.702 paper# 16)


c:\work\Jor\vol702_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 289-292
Patterns of Maxillofacial Fractures Associated with Assault Injury in
Khamis Mushait City and Related Factors
Ali Mohammed Alqahtani
College of Dentistry, King Khalid University

ABSTRACT
Objective:
The objective of this study was to explore the patterns of maxillofacial fractures associated with
assaults among male patients in Khamis Mushait, Saudi Arabia.
Methods:
This study was a retrospective study conducted in Armed Forces Hospital Southern
region(AFHSR) in Khamis Mushait City. The patients' records were investigated and full-detailed records
were included. Demographic data as well as type, location and cause of the maxillofacial fractures were
obtained. Results: A total of 215 patients' records were recruited for this study. Patients with age from 15
to 25 years were more than other age groups. Most of the patients were not Saudi citizens. About 68% of
patients completed their primary school or were illiterates. Nearly half of the fractures (49%) were found in
the dentoalveolar site. Mandible was more affected than maxilla. Left side was more affected than right
side. Blunted injuries were more frequent among patients than penetrated injuries. Patients with age 35
years were more suspected to have fractures than those with older ages.
Conclusion: Assault and violence can result in considerable maxillofacial traumas. Dentoalveolar fractures
were the most common fractures. Young patients were more affected than elders. This problem should be
taken as a general health problem and the actions should be taken to prevent further problems.
Keywords: Maxillofacial Fractures , Assault Injury , Khamis Mushait City.

INTRODUCTION

Incidence of maxillofacial fractures is not the
and regular treatment and management of almost
same among all countries; it varies widely due to
all cases including the maxillofacial fractures.
different factors (1-3). The management of such
The aim of this study was to identify the trend of
fractures is still a challenge for the oral and
maxillofacial fractures among male attendants
maxillofacial surgeons because it requires a high
and to identify the main associated risk factors.
level of skill and expertise (4). In general, the main

causes of maxillofacial injuries which have been
METHODS
recognized globally are road traffic accidents,
The hospital records of male patients with
followed by assaults, falls, and sports (5, 6). Some
maxillofacial fractures in Armed Forces Hospital
authors have reported that road traffic accidents
Southern Region (AFHSR) were retrieved for the
are the most frequent cause of maxillofacial
period 2000-2015. Patient was included if the
injuries (7, 8). However, some others, in more
record highlighted assault injury as the cause of
recent researches, have reported that assaults,
maxillofacial fractures. Unfilled or incomplete
specifically in developed countries, are the most
records were excluded. The records with different
frequent cause of maxillofacial injuries followed
causes were also excluded even if they included
by road traffic accidents (9-11). Nasal fractures
assault as one of the causes. Patients' records
followed by zygomatic arch fractures have been
were included in this study to identify pattern,
reported as the most common facial fractures.
site, type, and side of fracture. Moreover,
Some factors can contribute in increasing the
presence of combined fractures, mechanism of
maxillofacial fractures incidence such as:
injury and other serious complications were
increasing populations, socioeconomic activities,
reported. The demographic characteristics include
and increase road transportations (7, 12). Exploring
age,
nationality,
educational
level,
and
the trend and identifying the patterns and types of
occupation were also collected from patients'
maxillofacial fractures is valuable as it provides
records. Study protocol was approved by the
important information about fractures and causes
Ethics Committee at the AFHSR. Data were
which in turn can help in the prevention
entered into the master sheet and were then
programs. Armed Forces Hospital Southern
analyzed using the software program SPSS V.22.
region(AFHSR) in Khamis Mushait was
A P value less than 0.05 was detected as
established in 1964; it is among the major
statistically significant.The study was done after
hospitals in Saudi Arabia. It provides emergency
approval of ethical board of King Khalid

University.
289
Received: 12/10/2017 DOI: 10.12816/0043091
Accepted: 22/10/2017

Full Paper (vol.702 paper# 17)


c:\work\Jor\vol702_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 293-297

Hypertension in Adolescent School Girls in Riyadh City, KSA
Furat Abdulrahman Almayouf, Noha Dekhail Aldekhail
College of Medicine, Qassim University, Almulida, Saudi Arabia
ABSTRACT
Background:
Recent data from large samples of healthy adolescents show that the rates of hypertension
and prehypertension in adolescents are greater than expected and are increasing. Children with elevated
blood pressure can develop target organ damage. This work aimed to estimate the prevalence of
hypertension and to describe some related characteristics of cases in adolescent preparatory and secondary
school girls of Riyadh city, KSA. Methods: A cross-sectional study conducted among a cluster sample of
adolescent preparatory and secondary school girls of Riyadh city, KSA during the academic year 2016-
2017. Data collected via a predesigned and pretested questionnaire to collect the relevant data. Results: In
the studied adolescent girls, 6 (3.8%) were hypertensive; previously diagnosed and on treatment, 0.6% were
ex-smoker and 1.9% were smokers. Two girls (1.2%) had renal disease, 2.4% had bronchial asthma, one
girl (0.6%) had hypothyroidism and 0.6% had depression. Half of the cases aged 18 years, 33.3% aged 17
years and 16.7% aged 19 years (Mean (SD) age of cases was 15.3 ( 2.8)). Conclusion: in adolescent
preparatory and secondary school girls of Riyadh city, KSA, 3.8% were hypertensive. So health-care
providers should recognize the increased risk of prehypertension and hypertension and should seek to
identify and manage the modifiable risk factors in those adolescent girls.
Keywords: Hypertension; Adolescent; School Girls; Riyadh City, KSA.

INTRODUCTION


Hypertension is a persistent elevation of
Saudi national norms [5]. Another cross-sectional
arterial blood pressure (BP) above levels
study of hypertension in adolescent girls of
arbitrarily defined as normal. It is the most
district Moradabad, Uttar Pradesh, India found
common cardiovascular disease, and a public
that; nearly 15.8% adolescents were found pre-
health challenge for societies in socioeconomic
hypertensive, 1.5% were having stage I
and epidemiological transition, and one of the
hypertensive and 0.7% of the girls were stage II
most important risk factors for cardiovascular
hypertensive [6].
death, accounting for 20- 50% of all deaths

around the world [1] .The importance of
OBJECTIVE
hypertension in the pediatric population has not
This work aimed to estimate the prevalence of
been as well appreciated as in adults. Children
hypertension and to describe some related
with elevated blood pressure (BP) can develop
characteristics of cases in a sample of adolescent
target organ damage [2] .Adolescence in girls has
preparatory and secondary school girls of Riyadh
been recognized as a special period which
city, KSA.
signifies the transition from girlhood to

womanhood. Globally, adolescent girls constitute
SUBJECTS AND METHODS
about 1/5th of total female population [3]. Recent
A cross-sectional study was conducted among
data from large samples of healthy adolescents
a sample of adolescent preparatory and secondary
show that the rates of hypertension and
school girls of Riyadh city, KSA during the
prehypertension in adolescents are greater than
academic year 2016-2017. The sample size was
expected and are increasing [4]. A cross-sectional
calculated using the sample size equation n=
study was conducted among 146 boys and girls
z2*p(1-p)/e2 considering the prevalence of type I
attending intermediate and secondary schools in 2
diabetes in Riyadh is 50%, target population less
regions (Al-Mallaha and Al-Mubarraz) in the
than 1000 and study power 95%.
Eastern Province of Saudi Arabia found that 30%
Data collection: participant students were given
had systolic blood pressure (SBP) of 140 mm
a predesigned and pretested questionnaire to
Hg and 22% had diastolic blood pressure of 90
collect the relevant data on Socio-demographic
mm Hg. For girls between 13 and 16 years old,
characteristics including grade, mother and father
the SBP was greater than the 95th percentile of
293
Received: 3/10/2017 DOI: 10.12816/0043092
Accepted: 13/10/2017

Full Paper (vol.702 paper# 18)


c:\work\Jor\vol702_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 298-302

Squint in Children and Adolescents, Arar, Northern Saudi Arabia
Hadil Mohammed Alenezi1, Nagah Mohamed Abo El-Fetoh2, Adhwaa Saud Alruwaili1, Wasan Lafi
Alanazi1, Najah Salah F Alanazi1, Mona Salah F Alanazi3, Shahad Lafi Alanazi3, Taif Shayish
Alanazi3, Basmah Abdullah S Alanazi3, Ohud Falah Alanazi3, Abdurhman Aiash Alrwaili3

1 Medical Intern, Faculty of Medicine, Northern Border University, Arar, 2 Associate Professor of
Community Medicine, Faculty of Medicine, Northern Border University, Arar ,3 Medical Student,
Faculty of Medicine, Northern Border University, Arar, kingdom of Saudi Arabia

ABSTRACT
Background:
Squint, crossed eyes and deviating eyes is a condition in which the eyes do not properly
align with each other when looking at an object. A child with squint may stop using the affected eye. This
can lead to visual loss called amblyopia, which can become permanent unless treated early in childhood.
The aim of the study was to estimate the prevalence of squint, some determinants and clinical
manifestations and treatment characteristics in the studied children and adolescents in Arar, Northern
Saudi Arabia. This was a cross-sectional study, conducted in Arar, Northern Saudi Arabia. The study
included 156 randomly selected participants (62 male and 94 female children and adolescents).
Results: This study reported squint in 14.7% of the studied sample, 26.1% were females and 73.9% were
males. There was no significant relation between squint and age, other hereditary diseases or other
chronic diseases but there was relation with consanguinity between parents (P=0.03). The cause of squint
was eye trauma in 17.4%, surgical operation in 4.3% and neurological disease in 4.3%. Squint was right
sided in 47.8% of cases, left sided in 34.8% and in both eyes in 17.4% of the studied cases. 78.3% of the
cases had inward squint and 17.4% outward squint. In 8.7% of the cases squint alternate between eyes.
Temporary squint found in 52.2% and 78.3% of squint cases use glasses. In all cases squint affect visual
acuity. All cases received treatment (69.9% medical and 30.4% surgical) but only 52.2% cured and 43.5%
had recurrence. Conclusion: This study reported squint in 14.7% of the studied sample, 73.9% were
males. There was significant with sex and consanguinity between parents (P=0.03). The etiology was eye
trauma, eye surgical operation and neurological disease. Large scale screening studies is mandatory.
Health education of the public about causes and importance of early treatment is important
Keywords: Squint; strabismus; prevalence; causes; Arar; Saudi Arabia.

INTRODUCTION

or eye strain. To avoid double vision, the brain
Strabismus is the medical term for an eye
may adapt by ignoring one eye. In this case, often
condition commonly called by various names:
no noticeable symptoms are seen other than a
Squint, crossed eyes, walleyes, wandering eyes,
minor loss of depth perception.
goggle eyes and deviating eyes [1]. It is a
It is estimated that 4% of children suffer from
condition in which, the eyes do not properly align
strabismus. It is a public health problem for
with each other when looking at an object [2]. A
which all actors must be mobilized [7]. The
child with a squint may stop using the affected
frequency of strabismus is between 0.99 and
eye. This can lead to visual loss called
2.6% in Europe. Matsuo, estimated it at 1.26% in
amblyopia, which can become permanent unless
2003 and 0.99% in 2005 [8].
treated early in childhood. This treatment usually
A previous study in KSA [9] reviewed the
involves patching the good eye, to force the use
files of 385 children, with a male/female ratio of
of the affected eye. Sometimes surgery is needed
1.1:1.0. The group aged 06 years made up the
to correct the appearance of a squint [3].
largest group (P = 0.01). Strabismus was
Strabismus may lead to a failure to develop
prevalent with a percentage of (36.9%).
binocular vision, and amblyopia, either of which
Another study conducted in Ilorin, Kwara
may prevent an individual pursuing certain
State, Nigeria [10] reported that; a total of 7,288
occupations.
The
appearance
of
ocular
children were screened (3766 boys and 3522
misalignment may interfere with social and
girls). This yielded 32 cases of strabismus (19
psychological development with potentially
males and 13 females). Their age ranged from
serious effects for all patients with strabismus [4-
two to sixteen years old (mean, 9.5 + or - 6.0
6]. Symptoms of strabismus include double vision
years). The aim of the study was to estimate the
298
Received: 12/10/2017 DOI: 10.12816/0043093
Accepted: 22/10/2017

Full Paper (vol.702 paper# 19)


c:\work\Jor\vol702_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 303-307

The Relation between Breastfeeding and Incidence of Diabetes
Mellitus Type I in Saudi Arabia, Cross Sectional Study
Alnasyan Abdulrahman, AlDayel Osamah, AlZaid Abdulrahman, Al Menqash Ahmed
Imam Muhammad ibn saud Islamic University
College of Medicine, Riyadh
ABSTRACT
Background: Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial
risk-reduction strategies beyond glycemic control. Type 1 diabetes is due to autoimmune -cell destruction,
usually leading to absolute insulin deficiency. Since that prevalence of type 1 diabetes increased globally and
Saudi Arabia considered as one of the top 10 countries for number of children with type 1 diabetes. Our aim
is to know the relation between breastfeeding and incidence of diabetes mellitus type I during childhood in
Saudi Arabia, and to know if early weaning is a risk factor for diabetes mellitus type I. Methods: an online
cross sectional survey, written in Arabic language targeting both males and females' living in Saudi Arabia
from age 18 and below. Results: 407 participants 52.3% were diagnosed with type one diabetes and 47.7%
are free from type one diabetes. 45% of participants are fed by breastfeeding only, 45.9% are fed by
breastfeeding and formula while 9.1% were fed by formula only. 40.3% of participants were weaned at age
of six months or less, while 21.6% at age of seven to twelve month. 38.1% of participants were weaned at
age of thirteen to twenty four month. 52.3% of participants are diagnosed with type one diabetes with mean
age of diagnosis at 10.6 years old, median at 10 years old and mode at 12 years old. 26.3% of those who are
diagnosed with type one diabetes were fed by breastfeeding only while 59.6% were fed by breastfeeding and
formula. On the other hand, 14.1% are fed by formula only.Conclusion: Type 1 diabetes has genetic
predisposition, and as the affected relative is more closer, the risk is higher. Breastfeeding appears to be a
protective factor against type 1 diabetes, and it is associated with less risk of getting type 1 diabetes.
Keywords: diabetes mellitus, breastfeeding, pediatrics, Saudi Arabia, KSA.


INTRODUCTION

Since that prevalence of type 1 diabetes
have no evidence of b-cell autoimmunity.
increased globally and regionally by around
Although only a minority of patients with type
86,000 children develop type 1 diabetes each year
1 diabetes fall into this category, of those who do,
and Saudi Arabia considered as one of the top 10
most are of African or Asian ancestry. Individuals
countries for number of children with type 1
with this form of diabetes suffer from episodic
diabetes also its medical care represents an
ketoacidosis and exhibit varying degrees of
economic burden on countries budget expected to
insulin deficiency between episodes. This form of
spend more than 750 billion USD to treat diabetes
diabetes is strongly inherited and is not HLA
in 2040. So it is worth to spend time and money to
associated. An absolute requirement for insulin
study its protective, associated, causative factors.
replacement therapy in affected patients may be
Here, in our research we are studying whether that
intermittent3.
breastfeeding represents a protective effect for
There is global consensus on importance of
type 1 diabetes mellitus or not1. Diabetes is a
breastfeeding. It is known that breastfeeding is a
complex, chronic illness requiring continuous
protective factor of inflammation of the stomach
medical care with multifactorial risk-reduction
and intestines, colds, urinary infections, and ear
strategies beyond glycemic control type 1 diabetes
infections. In addition, breast-feeding reduces the
is due to autoimmune b-cell destruction, usually
risk of sudden infant death syndrome (SIDS) as
leading to absolute insulin deficiency2. It is now
well as the likelihood of child illnesses and
clear from studies of first-degree relatives of
allergies, such as asthma and eczema.
patients with type 1 diabetes that the presence of
Breastfeeding helps protect children from serious
two or more autoantibodies (islet-cell antibodies,
diseases such as childhood leukemia. It is found
insulin autoantibodies, autoantibodies to glutamic
that children and early adolescents who were
acid decarboxylase, the tyrosine phosphatase-
breastfed for the first six months were less at risk
related insulinoma associated 2 molecule, and the
for obesity compared to formula-fed babies. For
zinc transporter 8) is an almost certain predictor
example, when infants are breastfed through the
of clinical hyperglycemia and diabetes. Some
first six months of their lives, the rates of being
forms of type 1 diabetes have no known
overweight between their 9 to 12 years of age are
etiologies. These patients have permanent
22 percent lower than infants who don't get
insulinopenia and are prone to ketoacidosis, but
breastfed. In addition, there is some evidence that
303
Received: 12/10/2017 DOI: 10.12816/0043094
Accepted: 22/10/2017

Full Paper (vol.702 paper# 20)


c:\work\Jor\vol702_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 308-311

Length of Stay and Patient Satisfaction after Appendectomy
Momen Hadi S. Shawk1, Ali Mansour Taher Sumayli1, Mohammad Ali Mousa Daghriri1,
Khormi Ahmed Hadi A1, Mohammad Abdu sulaiman2, Saud Abdulaziz Musa Alqahtani1,
Alhazmi Ali Mohammed N1, Altaher Ahmed Hassan A1
1. Jazan University, 2. Ibn sina college
ABSTRACT
Objective:
This review to show the degree of patient satisfaction and length of stay after laparoscopic
appendectomy or open appendectomy. Moreover, the degree of appendicitis was considered either acute
appendicitis or perforated appendicitis which can result in complications like sepsis, peritonitis and
gangrene. Data sources: (PubMed, Google Scholar) have been searched for papers that addressed patient
satisfaction and length of stay after appendectomy, preoperative appendicitis status and the operation used
for appendectomy were considered during searching. Results: It was obvious that patient who have
undergone laparoscopic appendectomy were more satisfied and had short length of stay after the operation
neither than patients who have undergone open appendectomy who were less satisfied and had longer
length of stay. Also, it was clear that patient with acute appendicitis were more satisfied with short length
of stay neither than patients with perforated appendicitis who were less satisfied with longer length of stay.
Keywords: appendectomy, satisfaction, acute appendicitis, perforated appendicitis.

INTRODUCTION

Appendicitis is inflammation of the appendix. It
Although the symptoms of appendicitis are the
may be acute or chronic. It's more common in
same for adolescents as they are for adults, they
males than in females. Appendicitis is the most
may
begin
differently.
In
adolescents,
common reason for abdominal surgery in
appendicitis can begin as a vague stomachache
children. About four of every 1,000 children
near the navel. This pain may progress to the
under the age of 14 will undergo surgery called
lower right side of the abdomen.
an appendectomy to remove their appendix.
The study was done after approval of ethical
Appendicitis rarely occurs in children under the
board of Jazan university.
age of two, and mostly occurs in people between
Causes of appendicitis
the ages of 15 and 30.
In many cases, the cause for appendicitis is
symptoms of appendicitis.
unknown. There can also be multiple causes for
Nausea
one case of appendicitis1.
Vomiting
Doctors believe an obstruction in the appendix
Pain when touched on the lower right side of
may cause appendicitis. Obstruction may be
the abdomen
either partial or complete. Complete obstruction
Abdominal pain or tenderness, usually in the
is a cause for emergency surgery.
center of the abdomen above the belly
Obstruction is often due to an accumulation of
button, then shifting to the lower right
fecal matter. It can also be the result of:
side of the abdomen. The pain increases
enlarged lymphoid follicles
when moving, taking deep breaths,
worms
coughing, or sneezing.
trauma
Fever, usually low-grade (under 100 degrees)
tumors
Inability to pass gas
Types of appendicitis
Diarrhea
1-Acute appendicitis:
Constipation
IT is an inflammation of the appendix and is one
Abdominal swelling
of the most frequent causes of acute abdominal
Lack of appetite
pain. It is often treated surgically as an
If symptoms of appendicitis appear, it is
emergency. As we still do not know the real
important that the patient does not take laxatives
reason behind the occurrence of acute
or enemas to relieve constipation. These
appendicitis, it needs to be treated cautiously.
medications could cause the appendix to burst.
Some may get it because of an obstruction of
Patient should also avoid taking pain medications
food or fecal matter; others may get it due to an
that could mask the symptoms. The doctor would
infection2. Under certain conditions, the bacteria
need to know the diagnosis of the condition.
may multiply within the appendix. The appendix

may swell, and become filled with pus, and
308
Received: 12/10/2017 DOI: 10.12816/0043096
Accepted: 22/10/2017

Full Paper (vol.702 paper# 21)


c:\work\Jor\vol702_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 312-324

Role of MRI in Characterization of Benign Hepatic Focal Lesions
Mohamed Abdul Aziz Ali*, Ahmed Mohamed Hussein*, Rawnaq Ahmed Tuayen**
*Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, ** Basrah University

ABSTRACT
Background:
nowadays, magnetic resonance plays a key role in management of liver lesions, using a
radiation-free technique and a safe contrast agent profile. The heightened soft-tissue resolution and
sensitivity to intravenous contrast agents provided by magnetic resonance imaging (MRI) makes it an
invaluable problem-solving tool for fully characterizing focal liver lesions (FLL). Diffusion-weighted
imaging (DWI) sequences have been shown to be an emerging contributor for liver MRI and are being
incorporated in most abdominal MR protocols.
Aims
: To determine the role of MRI in characterization of benign hepatic focal lesions.
Patients and methods: This study included 30 patients (11 M, 19 F with mean age of 47.7 years) with
benign hepatic focal lesions. They were simple cyst (n =6), hemangioma (n = 11), abscess (n = 4), adenoma
(n = 2), focal nodular hyperplasia (n = 3), Hydatid cyst (n=1) and regenerative nodules (n = 3). They
underwent routine MR imaging and diffusion MR weighted imaging using 1.5 tesla MR unit (Philips
Achieva). Diffusion MR imaging was done using spin echo type of single shot echo planar imaging (EPI)
with b value of 0, &800 mm2/sec. The apparent diffusion coefficient (ADC) map was reconstructed and
ADC value was measured. The mean ADC values correlated with histopathological results as well as follow-
up imaging results. Results: The mean ADC values were significantly different within benign hepatic focal
lesions (P < 0.001). There was highly statically significant relation between cyst and hemangioma (p-value <
0.001), cyst and abscess (p-value <0.001), hemngioma and abscess (p-value < 0.001), while there was no
statically significance relation between adenoma and focal nodular hyperplasia (p-value < 0.74), adenoma
and regenerative nodules (p-value < 0.67) and focal nodular hyperplasia and regenerative nodules (p-value <
0.41). Conclusions: benign liver lesions are frequently encountered in clinical practice and their
characterization may be sometimes difficult. The problem of lesion characterization is mainly crucial and
may influence therapeutic decisions and patient's management. The role of imaging is therefore a mainstay
and MRI, with its multi parametric potentialities, is a highly accurate method for lesion detection and
characterization. Nevertheless, benign lesions may be sometimes "non-typic" in their cellular content and
vascular behavior and lesions biopsy can be necessary for definitive characterization.
Keywords: MRI, DWI, hepatic focal lesions.

INTRODUCTION
and help avoid unnecessary biopsy or costly
Nowadays, magnetic resonance plays a
follow-up imaging. MR imaging offers important
key role in management of liver lesions, using a
advantages over computed tomography (CT),
radiation-free technique and a safe contrast agent
such as the lack of ionizing radiation and
profile (1).The heightened soft-tissue resolution
improved soft tissue contrast (5). MRI can be used
and sensitivity to intravenous contrast agents
as the primary imaging examination for patients
provided by magnetic resonance imaging (MRI)
who cannot receive iodinated IV contrast material
makes it an invaluable problem-solving tool for
and patients in whom the liver is the only organ of
fully characterizing focal liver lesions (FLL)
concern. MRI is useful as a problem solving
(2).The majority of FLL arising in non-cirrhotic
technique when other imaging study showed
liver are benign, even in patients with known
equivocal findings (6).
extra-hepatic malignancy. Cysts, hemangiomas,
The American College of Radiology
focal
nodular
hyperplasias
(FNH),
and
Appropriateness Criteria assigned the highest
hepatocellular adenomas (HCA) are the most
rating to MR imaging with and without contrast
commonly encountered benign lesions (3). A
for characterization of indeterminate liver lesions,
tremendous development of new imaging
regardless of whether the patient is otherwise
techniques has taken place during these last years.
healthy, has liver disease, or has a known extra
Maximizing accuracy of imaging in the context of
hepatic malignancy (7). With the current state of
FLL is paramount in avoiding unnecessary
the art technology, magnets of 1.5 Tesla (T) and
biopsies, which may result in post-procedural
3T field strength are considered the standard of
complications up to 6.4%, and mortality up to
reference in providing high-quality and consistent
0.1% (4). Definitive characterization by magnetic
MR images. Giant advances in MRI have been
resonance (MR) imaging may alleviate patient
achieved in the last decade in regards to each of
anxiety, drastically alter management in someone
the following: hardware (high-performance
312
Received: 10/10/2017 DOI: 10.12816/0043097
Accepted: 20/10/2017

Full Paper (vol.702 paper# 22)


c:\work\Jor\vol702_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 325-328

Patterns of Maxillofacial Fractures Associated with Assault Injury in
Khamis Mushait City and Related Factors
Ali Mohammed Alqahtani
College of Dentistry, King Khalid University

ABSTRACT:
Objective:
The objective of this study was to explore the patterns of maxillofacial fractures associated
with assaults among male patients in Khamis Mushait, Saudi Arabia.
Methods:
This study was a retrospective study conducted in Armed Forces Hospital Southern
region(AFHSR) in Khamis Mushait City. The patients' records were investigated and full-detailed records
were included. Demographic data as well as type, location and cause of the maxillofacial fractures were
obtained.
Results: A total of 215 patients' records were recruited for this study. Patients with age from 15 to 25
years were more than other age groups. Most of the patients were not Saudi citizens. About 68% of
patients completed their primary school or were illiterates. Nearly half of the fractures (49%) were found
in the dentoalveolar site. Mandible was more affected than maxilla. Left side was more affected than right
side. Blunted injuries were more frequent among patients than penetrated injuries. Patients with age 35
years were more suspected to have fractures than those with older ages.
Conclusion: Assault and violence can result in considerable maxillofacial traumas. Dentoalveolar
fractures were the most common fractures. Young patients were more affected than elders. This problem
should be taken as a general health problem and the actions should be taken to prevent further problems.
Keywords: Maxillofacial Fractures, Assault Injury, Khamis Mushait City.

INTRODUCTION
management of almost all cases including the
Incidence of maxillofacial fractures is not the
maxillofacial fractures.
same among all countries; it varies widely due to

different factors (1-3). The management of such
The aim of this study was to identify the trend
fractures is still a challenge for the oral and
of maxillofacial fractures among male attendants
maxillofacial surgeons because it requires a high
and to identify the main associated risk factors.
level of skill and expertise (4). In general, the main

causes of maxillofacial injuries which have been
METHODS
recognized globally are road traffic accidents,
The hospital records of male patients with
followed by assaults, falls, and sports (5, 6). Some
maxillofacial fractures in Armed Forces Hospital
authors have reported that road traffic accidents
Southern Region (AFHSR) were retrieved for the
are the most frequent cause of maxillofacial
period 2000-2015. Patient was included if the
injuries (7, 8). However, some others, in more
record highlighted assault injury as the cause of
recent researches, have reported that assaults,
maxillofacial fractures. Unfilled or incomplete
specifically in developed countries, are the most
records were excluded. The records with different
frequent cause of maxillofacial injuries followed
causes were also excluded even if they included
by road traffic accidents (9-11). Nasal fractures
assault as one of the causes. Patients' records
followed by zygomatic arch fractures have been
were included in this study to identify pattern,
reported as the most common facial fractures.
site, type, and side of fracture. Moreover,
Some factors can contribute in increasing the
presence of combined fractures, mechanism of
maxillofacial fractures incidence such as:
injury and other serious complications were
increasing populations, socioeconomic activities,
reported. The demographic characteristics include
and increase road transportations (7, 12).
age,
nationality,
educational
level,
and
Exploring the trend and identifying the
occupation were also collected from patients'
patterns and types of maxillofacial fractures is
records. Study protocol was approved by the
valuable as it provides important information
Ethics Committee at the AFHSR. Data were
about fractures and causes which in turn can help
entered into the master sheet and were then
in the prevention programs. Armed Forces
analyzed using the software program SPSS V.22.
Hospital Southern region(AFHSR) in Khamis
A P value less than 0.05 was detected as
Mushait was established in 1964; it is among the
statistically significant.
major hospitals in Saudi Arabia. It provides
The study was done after approval of ethical
emergency
and
regular
treatment
and
board of King Khalid University.
325
Received: 12/10/2017 DOI: 10.12816/0043098
Accepted: 22/10/2017

Full Paper (vol.702 paper# 23)


c:\work\Jor\vol702_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 329-332
The Prevalence of Rhinitis and Its Association with Smoking in
A Nationwide Survey of Saudi Adults, 2017
Saud Mohammed Saud Aleisa, Abdulaziz Saud Fahad Aljuaid, Abdulaziz Fahad Altowairqi,

Ali Yasen Ali Ahmed , Abdulrahman Omar Mansy

Taif University
ABSTRACT
Background: Rhinitis is a common worldwide disease affecting more than 20% of people in many western
and developing countries as well.
Objectives: Assessing the prevalence of rhinitis and its association with smoking in a nationwide survey of Saudi
adults.Methods: A national wide survey based on a cross-sectional study conducted among general adult Saudi
population during the period from August to November 2017
Results: About 32.85% of the subjects suffered from nasal allergies, 29.5% suffer from runny nose, 31.4% had
sneezing and itchy nose and 28.9% had red and itchy eye. The overall prevalence of rhinitis after diagnosis and
revising the medical history of respondents was 32.8%. There was a significant association between the younger
ages, male gender with the prevalence of rhinitis. Also, a highly significant association was found between
smoking status and higher prevalence of rhinitis.
Conclusion: The overall prevalence of rhinitis was high among Saudi subjects and it was significantly associated
with smoking status. Educational programs and good lifestyle and habits would play an important role in
decreasing the prevalence of rhinitis among Saudi population.
Keywords: Rhinitis, prevalence, association, smoking, KSA.

INTRODUCTION
SUBJECTS AND METHODS
Rhinitis is a common worldwide disease that
Study design and setting:
associated with hypersensitivity of the nose
This was a national wide survey based on a
membranes due to immunological inflammation
cross-sectional study conducted among general adult
resulting from several types of allergens. Its
Saudi population during the period from August to
symptoms are associated with itchy and runny nose,
November 2017.
nasal obstruction as well as sneezing which reveal
Study population and sample size:
with or without using medication (1, 2).
This study included Saudi adult subjects aged from
It is a global disease affecting more than 20% of
20-60 years old living in thirteen governorates of
people around the world (3) and its increasing
Saudi Arabia. Adolescents and non-nationals were
prevalence was detected in many western and
excluded from the study. The sample size was
developing countries as well (4). The prevalence of
calculated using web calculator as the proportions of
rhinitis is associated with asthma with a higher
response to the questions is 50% and a margin of
prevalence among males in childhood and
error of 5%, a confidence interval of 5%(13) thus about
adolescence (5, 6) while during adulthood females are
2000 subjects were enrolled in the study. The study
more susceptible than males (7).
subjects were chosen from a number of different
The proper management of asthma include
governorates in Saudi Arabia to be able to generalize
identifying the causes of rhinitis and removing the
the findings.
allergen risk (8, 9). Various risk factors are associated
The study was done after approval of ethical
with etiology of rhinitis including genetic and
board of Taif university.
environmental
factors.
The
most
important
Study tools and data processing:
environmental risk factor is smoking and its
A questionnaire was adopted after reviewing the
association with rhinitis and asthma among children
available literature and studies conducted about
and adults (10-12)
rhinitis and its association with smoking. The

questions and validity of the questionnaire were
AIM OF THE STUDY
reviewed by the supervisors then tested by a pilot
This study aimed at assessing the prevalence of
study among 50 Saudi subjects. After the pilot study,
rhinitis and its association with smoking in a
the questionnaire was modified, validated and
nationwide survey of Saudi adults.
translated into simple Arabic form. The subjects were

divided into two groups according to having rhinitis
329
Received: 9/10/2017 DOI: 10.12816/0043099
Accepted: 19/10/2017


Full Paper (vol.702 paper# 24)


c:\work\Jor\vol702_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 333-341
Prevention of Surgical Site Infections: A Systematic Review
Abdulaziz Jubran A Arishi, Mohammed Ahmed H Ageeli, Saud Mohammed M Al Khayrat,
Lujain Abdu H Alamodi, Othman Ahmed Hakami, Majid Mosa Muhsin Maeshi
Faculty of Medicine, Jazan University

ABSTRACT
Introduction
: The preoperative interventions used for prevention of SSIs have different effectiveness in the
reduction of SSIs and subsequent surgical complications. This review aiming at evaluating the effectiveness
of various methods of prevention for SSIs.
Methods: The systematic search was conducted in Medline and Embase databases. This search identified
990 relevant studies using filters of human studies and 10 years since publishing. After exclusion of
irrelevant, duplicated, and reviews the remaining is 55 potentially relevant studies.
Results: The vast majority of studies were done in intra-abdominal procedures which were infection rate
varied from 0% to 38.4%. The rate of SSIs was higher than 25% in two studies used cephalexine as
prophylaxis, mohs micrographic surgery and assessed SSIs in perforated peptic ulcer. Intra-operative
warming used in only one study which reported SSIs rate of 18%. In case of using a combination of oxygen
and antibiotics the SSIs rate ranged from 7.9% to 38.4%. The lowest rate of SSIs was noted when antiseptic,
and amoxicillin were used together 0% and it was only 0.009% when cefazolin was used.
Conclusions:
The wide difference in infection rates among included studies may be patient-related and
procedure-dependent.

INTRODUCTION


Surgical site infection (SSI) is an infection that
The methods of prevention of SSIs mainly
follows an invasive surgical procedure. The
depend on preoperative antibiotic prophylaxis,
incidence of SSIs varies depending on the
other
methods
include
administration
of
definition of infection, the duration of
supplemental
oxygen
preoperatively
and
postoperative monitoring, the institution and the
application of normothermia during surgery (5).
type of performed surgical procedure. Surgical site
Skin sterilization is performed prior to surgery
injuries are serious complications in operations
using antiseptics to reduce the risk of SSIs by
that occur in approximately 2% of surgical
removing the soil and transient organisms from the
operations and constitute about 20% of health-
skin where a surgical incision will be made and
related injuries (1).
thus actually reduces wound infection after
Surgical site infections are associated with
surgery. Preparation of preoperative skin with
increased morbidity, mortality, and increased
0.5% chlorhexidine in methylactic spirits resulted
hospitalization, prolonged hospitalization on an
in a lower risk of SSIs compared with alcohol-
average of 4 to 7 days and twice the risk of fatal
based povidone iodine solution (6).
outcome, twice increased probability for ICU
The preoperative interventions used for
treatment, and five times greater chance of post-
prevention of SSIs have different effectiveness in
discharge hospitalization (2). Furthermore, due to
the reduction of SSIs and subsequent surgical
the prolongation of the illness and the
complications. This review aiming at evaluating
hospitalization, patients with SSIs suffer
the effectiveness of various methods of prevention
emotionally and physically, which results in
for SSIs.
prolonged absence from their usual activities,

social life and family disruptions due to the
METHODS
deterioration in their status and the insecurity
The systematic search was conducted in Medline
related to their health-related problems (3).
and Embase using search strategy of surgical
Although rates vary widely according to type of
wound or SSIs or surgical site, and infection or
procedure. SSI can have a devastating impact on
sepsis or contamination or abscess and prophylaxis
the patient's course of treatment and is associated
or antibiotic or antimicrobial or antiseptic or
with increased treatment intensity, prolonged
oxygen or normothermia. This search identified
length of stay, and higher costs (4). The complete
990 relevant studies using filters of human studies
eradication of SSIs is not practically possible,
and 10 years since publishing. After exclusion of
most of them are potentially preventable with the
irrelevant, duplicated, and reviews the remaining
help of efficient strategic prevention approaches.
is 55 potentially relevant studies. The protocol of
333
Received: 9/10/2017 DOI: 10.12816/0043100
Accepted: 19/10/2017

Full Paper (vol.702 paper# 25)


c:\work\Jor\vol702_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 342-344

Pattern of clinical Endocrine Practice in King Khalid University Hospital
Ahmed Mousa Almuhanna1 , Mohamed Almaatouq2, Esraa Abbas Bokhari3, Israa Mohammed
Alhajji4, Fatimah Mohammed AlAwadh4, Ali Mohammed Alsaihati5, Aqilah Ali Alabbad4, Marwah
Hussain Alkhamis 4, Zahra adel ali jaffal 6, Mohammed jawad busaleh4
King Saud University1, King Khalid University Hospital2 ,King Fisal Medical Complex,King Fisal
University,5Qatif Central Hospital,Almaarefa college

ABSTRACT
Background:
the endocrine system releases hormones that help control body functions including the
body's ability to change calories into energy that powers cells and organs. The endocrine system
influences heart beats, bones and tissues growth. It plays an important role in controlling blood glucose.
Moreover, it is associated with many disorders including thyroid disorders, growth disorders, and sexual
dysfunction. All endocrine glands release hormones into bloodstream.
Objective: The objective of this study was to define the types of diseases seen at the only endocrine clinic
in King Khalid University Hospital (KKUH).
Methods: we retrospectively analyzed the diagnosis data of all patients attending the endocrinology clinic
of the University Hospital in AL Riyadh city over a 7 weeks' period.
Results: The majority of cases had thyroid related diseases (48.6%) while 12.8% had gonadal and growth
diseases, 9.2% had Lipid, 7.3% had pituitary diseases, 5.5% were for wrong referrals, 5.5% and 4.9% had
adrenal & vitamin D deficiency related diseases respectively.
The lowest percentages were 3.7% for parathyroid and 2.8% for metabolic bone diseases.
Conclusion: Thyroid related disorders were found to be the most common endocrine disorders presented
to KKUH. Almost half of the patients had thyroid related disorders, accordingly we highly recommend
that extensive efforts should be in place to recruit experienced residents as well as continuously and
efficiently train existing ones on Thyroid related diseases.
Keywords: Endocrine Practice, Thyroid disorders, metabolic diseases, endocrine clinic, KKUH.

diagnostic data from the patients' files and
INTRODUCTION
defined their status to understand whether the
Endocrine and other metabolic diseases are

amongst the most common modern human

diseases, particularly in the United States and

other countries with generous nutrition and
cases were new or follow-ups, then we counted
screening programs for high-risk individuals. The
the percentages for each disease by using
prevalence and incidence of certain disorders,
calculator, we divided the number of patients for
such as diabetes and obesity, have been well
each specific disorder on the total of patients to
defined in large population-based studies (1).
know the percentage and pattern of clinical
There are manily 8 major endocrine disorders
endocrine diseases and practice.
identified; counting diabetes mellitus, thyroid

related disorders, parathyroid related disorders,
Data analysis
metabolic bone diseases, parathyroid related
The diagnosis for each clinical case was recorded.
disorders, pituitary diseases, lipid diseases,
Patients' diagnoses were the only data included in
adrenal related disorders growth hormone and
the analysis.
gonads diseases (2).
The study was conducted according to the
In the current study, we aim at defining the
ethical board of King Abdulaziz university.
types of diseases perceived at the only endocrine

clinic present in King Khalid University Hospital
RESULTS
(KKUH).


109 patients were enrolled in the present study.
METHODS
Data was reconciled at the end, the total weeks
This is an observational study of all patients
and interpreted in Table 1 and Figure 1.
attending the endocrinology clinic of the KKUH.
The majority of cases had thyroid related
Results were recorded over a 7 weeks' period
diseases (48.6%) while 12.8% had gonadal and
from February 2016 to March 2016 on every
growth diseases, 9.2% had Lipid, 7.3% had
Wednesday. We retrospectively retrieved their
pituitary diseases, 5.5% were for wrong referrals ,
342
Received: 10/10/2017 DOI: 10.12816/0043101
Accepted: 20/10/2017

Full Paper (vol.702 paper# 26)


c:\work\Jor\vol702_27 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 345-348

Assessment of Knowledge, Attitude and Practice towards Family
Planning in Saudi Arabia, 2017
Jumanah Ahmed Alsaedi1, Soliman Mohammed Alakel2, Abdulaziz Zaher Alalmaei3,
Moodhi Rabih Al-Mutairi4, Sultan Hamad Almutairi5.
1-Umm Al-Qura university,2-King Abdulaziz University,3-Imam Mohammd Ibn Saud Islamic
University, 4-Qassim university, 5-KSAUHS
ABSTRACT
Background:
Understanding the knowledge and conceptions of Saudi population regarding family
planning methods is important for increasing the public awareness and maintaining the health of the
women. Objectives: Evaluating the knowledge, attitude and practice (KAP) regarding the family planning
methods in Kingdom of Saudi Arabia (KSA).
Methods: A cross-sectional community questionnaire based study was conducted among 560 adult
married subjects in Saudi Arabia, from March to July 2017.
Results: The most of included subjects had college degree, less than 3 children and were employee. The
majority of subjects had good knowledge regarding the meaning, types and uses of contraceptives which
resulted in high attitude and good practice pattern as 65.4% of subjects had good KAP toward family
planning. Conclusion: The use of contraceptive types was quietly high among the Saudi subjects and this
could be due to that most of the subjects had high educational degree.
Keywords: knowledge, attitude, practice, family planning, contraceptives, kingdom of Saudi Arabia
(KSA)

INTRODUCTION

shopping malls distributed in different parts of
The women's health is a significant issue of
KSA. The inclusion criteria were Saudi Adult
many researches as improving the maternal
subjects and can read and write. All the
health and the sense of autonomy among women
respondents answered the questions of the
is associated with good family planning methods
questionnaire and gave a written approval for
(1, 2). Also, family planning is considered as a
participating in the study.
developmental step of a community(3, 4).
Study tools

The use of contraceptives is not only for limiting
The questionnaire was developed after
the family size and regulating the spaces between
reviewing the search engines including Science
births but also can be used as an indicator of
Direct, Scopus, Pubmed ...etc. The questionnaire
health and women's liberation(5).
was then validated by three supervisors in the
In Islamic countries including Saudi Arabia the
Family Medicine Department. The questionnaire
use of contraceptives is still low (6) and this could
included
4
parts
regarding
subject's
be attributed to the traditional of Islamic society
demographics, knowledge, attitude, and practice
for having many children (7, 8).
of family planning methods.
A gap was found among Saudi subjects regarding
Statistical analysis:
the knowledge and the real use of contraceptives
The SPSS version 20 was used for data entry and
during the reproductive period. Also, most of
processing. The quantitative data were shown as
them use contraceptives for making space
frequency and percentage. The KAP of the
between births instead of using the contraceptives
respondents was calculated where the correct
for decreasing the family number (6, 8).
answer takes 1 and wrong answer takes 0.


AIM OF THE STUDY
RESULTS
Evaluating the knowledge, attitude and
Demographics of the studied subjects:
practice (KAP) regarding the family planning
The age of included respondents ranged from
methods in Kingdom of Saudi Arabia (KSA).
20-45 years old with a mean of 39 years old. The

level of education was high among most of the
METHODS
subjects as 60.7% had a bachelor degree, 33.4%
A cross-sectional questionnaire community
had gone to secondary school while 5.9% of
based study that was conducted in KSA from the
subjects had a primary school. About 66.2% of
period of March to June2017 after obtaining
subjects were employee but 33.8% were jobless
approval from the research committee of Umm
or retired. More than half of the respondents
Al-Qura University. A simple random sample
(57.9%) had one or two children and 42.1% had 3
consisted of 560 subjects were interviewed in 20
children or more (Table.1).

345
Received: 11/10/2017 DOI: 10.12816/0043102
Accepted: 21/10/2017

Full Paper (vol.702 paper# 27)


c:\work\Jor\vol702_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 349-353

Endodontic Flare-Ups: A Study of Incidence and Related Factors
Ayshah Abdullah Alshehri1, Reem Abdullmuhsen Alshraim1, Azza Anas Abo Dawood1,
Areej Saleh Alhawsawi1, Maram Baker Ibrahim1, Abeer Hamed Almutairi1, Fares Awd Alzaidy2,
Amal Abdulkarim Aldouweghri3, Amal Ahmed Ali Nur4, Amany osama Kassem5
1Alfarabi Collage for Dentistry and Nursing(Jeddah),2Mansoura University(Egypt),3Ibn Sinaa National
College,4Alrazi University,5Future university(Egypt)

ABSTRACT
Background:
To assess the frequency of flare-ups and recognize the risk factors comprising age, initial
diagnosis, number of root canals, tooth type, gender, the type of irrigation regimen, the number of visits and
treatment modality, in patients who expected root canal treatment from May 2015 to May 2017.Materials and
Methods:
Records of 454 teeth belonging to 302 patients treated by endodontics expert throughout 2-year
period were kept. Tooth, patient, and treatment characteristics were assessed and the relations between these
characteristics and flare-ups were studied. Statistical analysis was carried out by using Chi-square test,
regression analyses, and exact test.
Results:
The incidence of flare-ups was 16 (3.5 %) out of 454 teeth that had endodontic treatment. Pulpal
necrosis without periapical pathosis was the most mutual symptom for flare-up (5.9 %) (P < 0.01). Teeth
undergoing multiple visits had a higher risk of developing flare-ups compared to those with single
appointments (OR: 3.27, CI: 1.216.91, p<0.01). There were similarly no statistically significant differences
in the frequency of flare-ups as regards to age, tooth type, gender, treatment modality, number of root canals,
and the irrigation solutions that utilized amid the treatment.
Conclusions:
The frequency of flare-up is insignificant when teeth are treated in one visit. Absence of a
periapical lesion in necrotic teeth is a significant factor for flare-ups.
Keywords:
Flare-up, Irrigation, Root canal treatment, Post-operative pain.

INTRODUCTION

A flare-up following a root canal treatment
inside the radicular canal system and the occurrence
appointment is a significant problem. The term flare-
of preoperative pain of periapical origin [9]; host
up is utilized normally to depict the improvement of
factors, for example, age, gender, and dental group
pain as well as swelling which begins a few hours or
[10]. Amid these factors, the amount of
days after root canal processes and is of significant
microorganisms and their outcomes entrenched [1].
seriousness to need an unscheduled visit for
For that reason, impeccable antimicrobial treatment
emergency treatment [1]. Absence of correct meaning
protocol for teeth with apical periodontitis ought to
of flare-up brought about assessed recurrence
have the capacity to remove bacteria in addition to
differences from as low as 0.39 % to 20 % [2, 3]. Iqbal
microbial virulence factors, which may add to the
et al. indicated that without any gold standard, and
perpetuation of periapical inflammation procedure
on account of the variable definitions, comparison of
[11]. Various antibacterial and chelating substances
flare-up frequency through studies is challenging [2].
have been suggested for cleaning and forming of
There are various motivations to recognize
root channels. Amid these substances, sodium
hazard factors for flare-ups. An organization may
hypochlorite (NaOCl) and chlorhexidine (CHX) are
wish to attempt an internal study, recognize hazard
two normal intracanal irrigants that have presented
factors, and may change protocols to enhance
great antibacterial action [12]. Harrison et al. [13]
outcomes. On the off chance that legitimately
studies that there was a greater rate and level of pain
distinguished, the peri-operative indicators of flare-
in individuals whose canals were either not irrigated
up combined with the specialist's experience may
or irrigated with saline solutions, contrasted with
support to better oversee patients post-operatively [2].
those irrigated with 5.25 % sodium hypochlorite and
Numerous hazard factors have been studied to
3 % hydrogen peroxide solutions. Notwithstanding
illustrate which factors can be correlated with the
its great antimicrobial movement, NaOCl has a huge
incidence of flare-ups. These incorporate the intra-
toxicity when expelled into periradicular tissues [14].
canal treatment utilized [4]; number of visits to finish
In this manner, it is fundamental to keep away from
the treatment [5]; periradicular diagnosis [6]; pulpal
apical expulsion amid irrigation to not add to inter-
diagnosis [7]; apical extrusion of debris; and whether
appointment uneasiness.
or not apical patency was preserved through
The purpose of this examination was to assess
preparation [8]. Kind of treatment, whether original
the frequency of flare-ups and recognize the hazard
treatment or retreatment [1]; presence of irritants
factors comprising age, initial diagnosis, number of
349
Received: 14/10/2017 DOI: 10.12816/0043103
Accepted: 24/10/2017

Full Paper (vol.702 paper# 28)


c:\work\Jor\vol702_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 354-356
Targets for Non-invasive Skin Tightening
Lama N. Alotaibi
Al-Maarefa Colleges for health sciences,Riyadh, Saudi Arabia
Corresponding author: Lama N.alotaibi, Telephone : +966599543218,Email: Lama93@live.com

ABSTRACT
Noninvasive skin tightening is a technology done to lift the skin without even minimal penetration to skin
layers. Therefore, cosmetic surgeons can effectively tighten moderately lax or creepy skin on the face, neck,
and body, helping patients improve their appearance without surgical intervention. It works on stimulating
collagen reproduction by inducing heat to the deep layers of the skin. There are two types of skin tightening
technology; MFU (Microfocused ultrasound) and Non-Ablative Radiofrequency.
This article focus on MFU, its efficacy, safety, complication and patients who are suitable for MFU.
Keywords: radiofrequency Microfocused ultrasound noninvasive skin tightening - laxity

INTRODUCTION

Noninvasive skin tightening or lifting is a
2) Microfocused ultrasound (MFU)
nonsurgical recent technology. In general, non-
MFU uses much lower ultrasound energy to treat
surgical skin tightening procedures work by using
the superficial layers of the skin. MFU uses 0.41.2
targeted energy to heat deeper layers of skin, which
J/mm2 of energy, a frequency of 410 MHz, and a
stimulates collagen and elastin synthesis in the deep
focal depth of only 1.54.5 mm.(2) MFU depends
dermis and subdermal tissue thus gradually
only on heating the tissue of minimum 60C up to
improves and effectively tighten moderately lax or
"creepy" skin on the face, neck, and body, helping
70C, producing small (<1 mm3) thermal
patients improve their appearance and postpone the
coagulation points to a depth of up to 5 mm within
need for surgery. This brought a significant
the mid-to-deep reticular layer of the dermis and
improvement and satisfaction of skin lifting from 3
subdermis while sparing overlying papillary dermal
months up to 6 months depending on several factors
and epidermal layers of skin.(3)This technology
that can affect the results like patient's age, skin
depends only on using the heat of minimum 60 up to
laxity, selected area and the amount of energy used at
70C focused specifically on one area to achieve
this area. The demand for noninvasive skin/aesthetic
collagen
denaturation,
contraction,
and
treatments has grown significantly over the past
neocollagenesis enhancement.(4) When collagen is
several years.
exposed to 60C- 65C, it undergoes denaturation.
Patients seek these kinds of treatments and
One study showed that new collagen synthesis is
doctors are more than willing to deliver them, once
observed after 30 days and another study showed
they prove their safety and efficacy in clinical trials.
that new collagen and elastin synthesis observed at
Skin tightening could be done for several sessions
ten weeks, along with the deposition of hyaluronic
using one of the two technologies;
acid.(5,6). Since MFUS device can penetrate deeper
1. RF (Non-Ablative Radiofrequency.)
into tissue than its nonsurgical predecessors to affect
2. MFU (Microfocused ultrasound).
superior tissue tightening and longevity of results by

selectively
targeting
the
superficial
1)
Radiofrequency (RF)
musculoaponeurotic system(SMAS). SMAS is a
RF energy is not new in aesthetic medicine; in
subcutaneous, fan-shaped structure that covers the
(7)
fact, it has been a staple in skin tightening since
face and connects the facial muscles with the
2001. The effects of dermal heating are well-
dermis(8). The SMAS layer composed of collagen and
recognized and include immediate effects on
elastic fibers similar to the dermal layer of the skin;
collagen structure with stimulation of dermal
however, it has more durable holding property and
fibroblasts inducing a synthesis of new collagen
less delayed relaxation after lifting procedures than
fibers (known as neocollagenesis) and elastic fibers
skin alone.(9) Thus, the SMAS is a desirable target for
(known as neoelastogenesis).(1) However, this less
noninvasive skin tightening procedures.
invasive approach is historically associated with

inferior efficacy so that surgery remains the
Ulthera Microfocused ultrasound system
treatment of choice to address moderate to severe
Ulthera system (Ultherapy), a high-resolution US
tissue laxity.
system approved in 2009 by the US Food and Drug
354
Received: 13/10/2017 DOI: 10.12816/0043104
Accepted: 23/10/2017

Full Paper (vol.702 paper# 29)


c:\work\Jor\vol702_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 357-363

Perceptions about Sickle Cell Disease among Adults in
Albaha Region: A Cross-sectional Study
Abdulrahman A.M. Alghamdi, Ali M.A. Alamri, Abdulrahman H.A. Alghamdi,
Saeed Y.S. Alghamdi, Fares A.M. Alzahrani, Saeed A.S. Alzahrani, Ayedh Mobarak Albishi
Faculty of Medicine, Albaha University, Albaha, Saudi Arabia
ABSTRACT
Background:
Sickle-cell disease (SCD) is a group of genetic disorders characterized by abnormally shaped red
blood cells (RBCs), which are destroyed at increased rates, leading to anemia. Recently, Saudi Arabia has been
reported to have an increased prevalence of SCD.
Objective: The aim of the present study was to assess perceptions about SCD among the general population in
Albaha region, Saudi Arabia, and the possible relationship between their levels of knowledge and socio-
demographic characteristics. Methods: The study was carried out on 218 Saudi subjects who completed the self-
administered questionnaires during the study period. Results: This study demonstrated that more than two-thirds
of the respondents (68.80%) had good knowledge about basics of sickle cell disease. Those with poor knowledge
(31.20%) were mainly younger males and works as businessmen and housewives, and all of them had no previous
experience with SCD child. Despite the recorded favorable level of knowledge, certain gaps in knowledge were
identified; most of them falsely believed that some foods like fava beans, lentils, falafel made with fava beans,
vigna and /or nuts could precipitate sickle-cell crisis.Moreover, in depth information of our study population
about pattern of inheritance of SCD and its complications were not sufficient.
Conclusion: In our study, a good level of awareness regarding SCD was found. Some of the respondents were
confused about the nature of inheritance, complications and dietary factors related to the disease. So, community
health education meetings and/or media programs to increase the public awareness are recommended.
Keywords: sickle-cell disease; awareness; perception; misconceptions; survey; Albaha; Saudi Arabia.

INTRODUCTION

Sickle-cell disease (SCD) is a group of genetic
community-based surveys conducted on African
disorders characterized by abnormally shaped red
Americans in large urban areas demonstrated limited
blood cells (RBCs), which are removed from the
awareness of SCD in these communities(6). In
circulation and destroyed at increased rates, leading
addition, Adewoyin and colleagues(7) demonstrated
to anemia(1). The presence of hemoglobin S is the
a moderate level of public health knowledge
main pathological factor for the development of
regarding SCD in Nigeria.
SCD. When hemoglobin S becomes deoxygenated, it
In the Middle East, Al Arrayed & Al Hajeri(8)
forms aggregates with other hemoglobin molecules
reported a good level of knowledge about SCD
within the RBCs(2). In addition to anemia, SCD can
among the public in Bahrain, and there are wide
lead to blood vessels obstruction and infarction of
acceptance and appreciation of the SCD prevention
different body organs. A point mutation in the gene
campaigns being conducted in Bahrain.
coding the chain of the hemoglobin molecule
Recently, Saudi Arabia has been reported to
resulted in a single amino acid substitution (valine
have an increased prevalence of SCD. The carrier
for glutamic acid), which leads to hemoglobin S. It is
status for SCD ranged from 2% to 27%, and up to
estimated that more than 200 000 babies are born
1.4% had SCD in Saudi Arabia(9). In addition, the
with the disease each year in Africa alone(3). In
prevalence of consanguinity ranges from about 60
addition, it is a prevalent disorder among those from
percent in Saudi Arabia up to 90 percent in some
Mediterranean area countries like Turkey and the
Bedouin communities(10). Therefore, it is important to
Arabian Peninsula(4).
assess the perception of the public in Saudi Arabia
Recently, a marked improvement in life
about the SCD.
expectancy and quality of life among SCD patients

have been reported, which is mainly attributed to
METHODS
the advances in general prophylactic and other
Ethical considerations
corrective measures(5). However, proper public health
This study was conducted after approval of the
awareness about SCD and its complications remains
Institutional Review Board of the Faculty of
an important item in the management of SCD. Early
Medicine, Albaha University. All participants
357
Received: 12/10/2017 DOI: 10.12816/0043105
Accepted: 22/10/2017

Full Paper (vol.702 paper# 30)