c:\work\Jor\vol703_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 364-370

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

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.


Vitiligo vulgaris is defined as an

and Cu levels in vitiligo patients and their relation
manifested by depigmentation of the epidermis
to the etiopathogenesis of vitiligo.
resulting from destruction of melanocytes (1).

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

and surgery. These treatment options have limited
Inclusion criteria
success (7). The best evidence is for
Vitiligo patients
applied steroids and the combination of UV
All types of vitiligo
light in combination with creams (8).
Both sexes
Zinc (Zn) and copper (Cu) are two of the
Age from 15 to 60 years
trace elements that found in small amounts in the
Exclusion criteria
body (9). Zn and Cu are involved in many
Presence of leukoderma secondary to other causes.
homeostatic mechanisms of the body, such as
History of other obvious skin diseases.
specific immunity, inflammation and oxidative stress
Undergoing treatment with zinc or any history of
(OS) (10). Decreased serum Zn and Cu levels have
zinc intake for 6 weeks before this study. Suffering
been reported in vitiligo by some investigators (11),
from any other systemic diseases such as: hepatic
while others contradicted these findings (11).
cirrhosis, viral hepatitis, neoplastic condition,
Aim of study: this study aimed to detect the
myocardial infarction, steatorrhea, or renal failure,
possible changes in the metabolism of serum Zn
pregnancy or consumption of oral contraceptive
Received: 3/10/2017 DOI: 10.12816/0043470
Accepted: 13/10/2017

Full Paper (vol.703 paper# 1)

c:\work\Jor\vol703_2 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 371-375
Awareness of Radiation Protection Measures among
Radiologists and Non-Radiologists
Khaled Awdah Algohani1, Ali Abdullah Aldahhasi 2, Abdullah Hassan Algarni 2,
Khaled Yahya Amrain 2, Majed Abdulkarim Marouf 2
1-Royal Commission Hospital, 2-King Fahad Hospital, 3-Al Noor Specialist Hospital
Email: k.alorfi@hotmail.com
More than 3,600 million radiology examinations are carried out every year worldwide. In
spite of the great benefits of diagnostic and therapeutic radiations, they may result in some hazards if used
inappropriately. However, these hazards can be prevented through raising the awareness of health care
professionals about these hazards and the protective measures to be considered. Several guidelines and
regulations were issued for this purpose including; the POPUMET regulations and ALARA principle and
the WHO global initiative on radiation safety in health care settings.
The current study aimed at assessing the level of radiation protection awareness among clinicians and
radiologists in addition to exploring if radiation protection courses have a beneficial effect on the awareness
level or not. Methods: This was a cross-sectional study where the level of radiation protection awareness
was assessed using an anonymous questionnaire.
A total of 101 (100%) participants responded to the questionnaire. Of which; 49 (48.5%) were
residents, 30 (29.7%) were specialists and 22 participants (21.8%) were consultants.
Slightly less than half of the participants (48, 47.5%) have attended a radiation protection course before.
The majority of participants who attended a course (68.8%) have heard about the POPUMET regulations
Participants were asked about the procedures with risk equivalent to 0.25 mSy of radiation estimated dose
equivalent. And it was found that course attendance improved the knowledge about the risk of 3 (out of 4)
procedures (p<0.05). On the other hand, course attendance didn't improve the knowledge about the
approximated radiation doses of some procedures (p>0.05) or the degree of radio-sensitivity of different
organs (p>0.05). The majority of the participants (96%) were not aware that there is no annual limit of
radiation dose for patients. Around half of the participants (56.4%) were aware about what the word
"ALARA" stands for.
Conclusion: Results of the current study suggested that the level of radiation protection awareness among
health care professionals is not sufficient to ensure patients and workers' safety. And accordingly, we
suggested that more efficient awareness programs for health care professionals are conducted on regular
basis with regular monitoring of awareness level to explore areas for improvement.
radiation, POPUMET, ALARA, awareness.


According to the United Nations, more than
undergoing medical treatment or examination. This
3,600 million radiology examinations are carried
includes; the POPUMET regulations, ALARA (as
out every year to diagnose several diseases all over
low as reasonably achievable) principle and the
the world. In addition, 37 million procedures
WHO global initiative on radiation safety in health
including nuclear medicine are carried out and 7.5
care settings. These guidelines and principles
million treatments including radiotherapy are given
integrate radiation protection with good medical
every year1.There is no doubt that therapeutic and
practice to allow all stakeholders of healthcare
diagnostic applications of ionizing radiation help
services to comply with radiation safety standards.
millions of people all over the world every day.
The main concepts of this initiative includes risk
However, these benefits may be associated with
unnecessary however preventable risks to patients,
communication strategies 3.
technicians and healthcare givers if radiation is not
It was reported in a study by Kings, et al. that
used appropriately. These risks are now minimized
physicians and other health professionals, need to
because of the development of advanced
be aware of radiation hazards and protection
technologies that makes these applications safer2.
techniques in order to get the required benefits from
Several regulations were released to raise the
radiation while minimizing the associated risks 4 .
awareness about radiation hazards and the
Salih ,et al. conducted a study in 2013 to assess the
techniques to be followed for protection of patients
awareness and knowledge of Saudi medical
Received: 21/10/2017 DOI: 10.12816/0043471
Accepted: 1/11/2017

Full Paper (vol.703 paper# 2)

c:\work\Jor\vol703_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 376-381

A Survey on Jazan Public Awareness about
The Role of The Anesthesiologists
Ahmad Ali Mohajer, Ali Yehya Matiri, Ahmed Ali Jaafari, Naif Ayidh Almalki,
Abdulaziz Mohammed Alfaqih, Abdulrahman Hussain Gosada, Hussein Ahmed Sanba ,
Khamis Abdu Khamis , Rayan Thabet Shayani
Faculty of Medicine, Jazan University

anesthesiology has been considered as a behind the scene specialty. Most patients lack the
knowledge about the anesthetist's role and there are few who know about anesthesia, but still considered
having poor knowledge. People thought that anesthetist plays a secondary role in surgery and the role
assigned to the anesthesiologist remains inaccurate for most of them.
Aimof the work: our study aimed to assess the society's perception in Gazan area of Saudi Arabia about
anesthetist's role and duties in surgery and their knowledge about anesthesia.
Method: a total of 744 responded to the questionnaire. Out of the responders, 445 (59.8%) were males, and
299 (40.2%) were females. 432 (58%) participant considered having sufficient knowledge about anesthesia,
while 312 (42%) still didn't have sufficient knowledge about it. 514 (69%) responders admitted that
anesthesia is safe, while 230 (31%) responders thought that it's not-safe.
Results: 744 participated in our study, out of which 445 (59.8%) were males and 299 (40.2%) were the
participated females. 432 (58.1%) of the sample study had sufficient knowledge about anesthesia, while 312
(41.9%) didn't having sufficient data. Our study also showed a correlation between the education level and
the knowledge about anesthesia and anesthetists.
Conclusion: our study revealed the poor knowledge of Gazan inhabitants about anesthesia, anesthetists and
pre-operative care. The poor knowledge may be due to the limited interaction between the anesthetist and the
patient, thus the anesthetist has the duty to visit the patient before surgery.
Keywords :
Anesthesia , Awareness , Jazan , Saudi Arabia.


Anesthesia is unique in because it is not a direct of regional anesthesia; the two most common are
mean of treatment and rather it allows other
spinal anesthesia and epidural anesthesia which is
physicians to do things that may treat, diagnose, or
often used during childbirth.
cure an ailment which would otherwise be painful Local anesthesia, the anesthetic drug is usually
or complicated.
injected into the tissue to numb just the specific

location of your body requiring minor surgery.
There are three main categories of anesthesia, each
You stay awake and alert.
having many forms and uses (1).

They are:
An anesthesiologists or anesthetists are physicians

trained in anesthesia and perioperative medicine.
General anesthesia, the patient becomes
They have a wide range of knowledge about
unconscious. He does not feel any painand would
medicines and care for diseases. They know how
not remember the procedure afterwards. There are
the human body works and how it responds to the
a number of general anesthetic drugs; some are
stress of surgery. Anesthesia specialists are
gases or vapors inhaled through a breathing mask
responsible for making informed medical decisions
or tube and others are medications introduced
about your care. They provide comfort and
through the vein.
maintain vital life functions, while you are getting
Regional anesthesia, the anesthetist makes an
anesthesia and during recovery (2).
injection near a cluster of nerves to block pain in

an area of the body that requires surgery. The
More than half of patients are unaware of the fact
patient may remain awake, or may be given a
that anesthesiologist have medical degrees and
sedative, either way he doesn't see or feel the
actual surgery taking place. There are several kinds
anesthesiology is one of the fastest growing
Received: 22/10/2017 DOI: 10.12816/0043472
Accepted: 2/11/2017

Full Paper (vol.703 paper# 3)

c:\work\Jor\vol703_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 382-385

The Incidence and Surgical Treatment of Gallstone
Cholecystitis in Rural Saudi Arabia
Mohammed Khaldun Alalwan, Naif Theeb Alqahtani, Humaidan Hamoud Almalki,
Abdulrahman Mohammed Aljowair, Anthony Morgan
Prince Sattam bin Abdulaziz University
Cholecystolithiasis and its complications remain to be one of the leading burdens in general surgery which
require surgical intervention in majority of cases. In Saudi Arabia, this pathology has huge impact on its health
system and society. In current management of acute and chronic cholecystitis as a result of cholecystolithisis,
laparoscopic cholecystectomy has become a procedure of choice. The aim of this cross-sectional study was to
estimate the incidence of cholecystitis as the complication of cholecystolithiasis in central rural area of Saudi
Arabia with relatively large population and analyze current management outcome in selected group of patients,
who underwent laparoscopic cholecystectomy procedure. Multiple criteria including demographics, results of
investigations and surgical outcome were analyzed and compared. The incidence of acute cholecystitis in this
study was 4.4/100,000 of population per year with prevalence of 24% and female to male ratio 11.9:1. The
results demonstrated satisfactory surgical outcomes with low complications rate and cost effectiveness.
Keywords: Cholecystitis, cholecystolithiasis, gallstone disease, laparoscopic cholecystectomy, gallstone


Gallstone related pathological conditions remain
Other risk factors contributing to the
one of the most frequent of the gastrointestinal tract,
development of gall stones include family history,
which affect population in all continents, but more
high body mass index (BMI), multiple pregnancies.
prevalent in regions with fast food culture and
Also, co-morbidities, which alternate physiological
absorption of bile in digestive system and could
Cholecystolithiasis is showing high prevalence in
become the predisposing factors like in Crohn's
developed countries reaching up to 21%. It is less
disease, ulcerative colitis or other liver pathologies,
significantly less common in the developing nations
which increase gall stone formation(1).
and remaining as low as 4.1% . However, majority of
Acute cholecystitis is defined by specific
the patients (near 80%) with diagnosed gallstones
clinical features and supported by ultrasound
remain asymptomatic for long time and may never
scanning evidence for surgical treatment. However,
have complications caused by the presence of
there is no universal approach for the timing of
surgery among different surgical centers(2).
gallstones during their entire life (1).
The aim of this study was to investigate
By estimation, near 20% of adult population by
incidence of acute gallstone cholecystitis and current
the age of 40 will develop biliary calculi with no
trends in approach for investigation and surgical
symptoms. This figure may be increased to 30% by
management of gallstone disease in central rural
the age of 70. However, only about 3% of patients
region of Saudi Arabia with large population.
will have periodical symptoms before develop acute

cholecystitis, which will require surgical treatment.

Currently in majority of literature reports, female-to-
male ratio is reaching about 4:1 in the reproductive
years, and close to equal ratio by the age of 60 and
This cross-sectional study was based on medical
above (1).
records from Prince Sattam bin Abdulaziz University
Socio-economic factors, fatty food diet and low
Hospital in Al Kharj province of Saudi Arabia
physical activity lifestyle are shown to correlate
covering the population of over 600,000 people with
directly with higher incidence of gallstone disease.
various demographics and socio-economic status.
Received: 22/10/2017 DOI: 10.12816/0043473
Accepted: 2/11/2017

Full Paper (vol.703 paper# 4)

c:\work\Jor\vol703_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 386-391

Management of Acute Vision Loss
Hadil Mohammed Alenezi1, Arwa Ziad Alromaih2, Aisha Abdullah Al-Essa2,
Razan Abdullah Aldawod2, Bashaer Abdulaziz Altowairqi3, Zainab Habib Almomen2,
Sara Mohammed Beayari4, Sakhr Ahmed Dawari5
1 Northern Border University, 2 Imam Abdulrahman Bin Faisal University, 3 Jazan University,
4 Umm Al-Qura University, 5 Al-Imam Mohammad Ibn Saud Islamic University
Corresponding Author: Hadil Mohammed Alenezi - Hadil_77@Hotmail.Com - 0535740435


Acute visual loss is a mutual complaint with variable presentations amid patients of different ages. The
degree of difference diagnoses of vision loss is immense. Generally, monocular vision loss regularly
specifies an ocular problem. Binocular vision loss is commonly cerebral in origin. Monocular vision loss
can respect the horizontal midline. Binocular vision loss can respect the vertical midline. Many diverse
causes of sudden visual loss are recognized; though, the most common cause for painless visual loss is
ischemia. Vision loss with positive scotoma may be seen with migraine. Vision loss with a negative
scotoma may be seen with amaurosis fugax. Ischemia, often via mechanical obstruction, can affect any
aspect of the visual system. Those who develop ischemia of the eye often have other evidence of
atherosclerotic disease, such as coronary artery disease and peripheral vascular disease, which increases
their susceptibility to ischemic events in other parts of the body. Risk factors include smoking,
hypercholesterolemia, and hypertension.
Keywords: Vision Loss, Migraine, Retinal detachment, retinal vein occlusion.


Acute visual loss is a mutual complaint with
visual loss include infection, inflammation,
variable presentations amid patients of different
trauma, vasculitis, mechanical dysfunction, and
ages. The degree of difference diagnoses of vision
idiopathic causes[3].
loss is immense. Generally, monocular vision loss
For any patient with sudden visual loss, the
regularly specifies an ocular problem. Binocular
following information should be obtained:
vision loss is commonly cerebral in origin[1].
Monocular vision loss can respect the horizontal
History of trauma
midline. Binocular vision loss can respect the
Whether one eye or both eyes affected
vertical midline. Some patients define their
Symptoms - Photophobia, headache, pain
symptoms as a progressively descending gray-
Duration of visual loss or changes
black curtain or as clouding, fogging, or dimming
Prior episodes/ophthalmologic history
of vision. Symptoms commonly last a few minutes
It is important to ask about comorbid conditions
but can persist for hours. Variation in frequency
for example, hypercholesterolemia arrhythmia,
ranges from a single episode to many episodes per
hypertension, cancer, collagen vascular disease,
day; recurrences may continue for years but more
hematological disorders, or medication use[4].
frequently occur over seconds to hours. Several
Funduscopy and visual field testing can be
diverse causes of sudden visual loss are
recognized; though, the most common cause for
completely rule out retinal detachment, as the
painless visual loss is ischemia[2].
retina is only partly visualized with these
Vision loss with positive scotoma may be seen
approaches. If accessible, ultrasound is a valuable
with migraine. Vision loss with a negative
adjunct to the physical examination of the eye.
scotoma might be seen with amaurosis fugax.
When the fundus cannot be visualized, ocular
Ischemia, often via mechanical obstruction, can
ultrasonography can reveal retinal detachment,
affect any aspect of the visual system. Those who
vitreous hemorrhage, vitreous detachment, ocular
develop ischemia of the eye often have other
tumors, increased intracranial pressure, retrobulbar
indication of atherosclerotic disease, for example,
hematoma, and intraocular foreign bodies [5].
coronary artery disease and peripheral vascular
Retinal detachment is evident by a taut, linear
disease, which increases their susceptibility to
opacity seen in the vitreous chamber that moves in
ischemic events in other parts of the body. Risk
conjunction with eye movement. Vitreous
factors contain smoking, hypercholesterolemia,
detachment appears as an opaque line separated
and hypertension. Other etiologies of sudden
from the retina that floats in the vitreous humor.
Received: 14/10/2017 DOI: 10.12816/0043474
Accepted: 24/10/2017

Full Paper (vol.703 paper# 5)

c:\work\Jor\vol703_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 392-396

Laparoscopic versus Open Inguinal Hernia Repair in Adults
Mansour Ali Shaiban1, Layan Mazen Khushaim2,Roaa Khalid Alghamdi2,
Fatimah Murtadha Alawami3, Mouhab Rafiq Jamalaldeen4, Ghadah Abdulsalam Aljoufi5,
Mohammed Hasan Alsharif6, Fetoon Nasser Alsharif2, Khaled Saad Alzahrani7, Sultan Omar
Albarakati2, Alqahtani Yousif Abdulrahman N8, Almutairi Ahmad Saud9, Mahdi Hussain Al-Saad10,
Ebtihal Mohammad Al-Khider11, Mohammed Zuhair Ismael7
1 Jazan University, 2 Ibn Sina National College, 3 Maastricht University, 4 King Saud University,
5 Princess Nourah Bint Abdulrahman University, 6 Umm Alqura University, 7 King Abdulaziz University,
8 Imam Abdulrahman Bin Faisal University, 9 Szeged University- Hungary, 10 King Faisal University,
11 Prince Mohammed Bin Nasser Hospital ­ Gizan
Corresponding Author: Mansour Ali Shaiban - Dr.mas14@gmail.com - 966550056562

Hernias are abnormal protrusions of a viscus (or part of it) through a normal or abnormal opening in a
cavity (usually the abdomen). They are most commonly seen in the groin; a minority are para-umbilical or
incisional. In the groin, inguinal hernias are more common than femoral hernias. Inguinal hernias occur in
about 15% of the adult population, and inguinal hernia repair is one of the most commonly performed
surgical procedures in the world. Although open, mesh-based, tension-free repair remains the criterion
standard, laparoscopic herniorrhaphy, in the hands of adequately trained surgeons, produces excellent results
comparable to those of open repair. We conducted this review using a comprehensive search of MEDLINE,
PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of
Controlled Trials from January 1, 1985, through June 15, 2017.
Keywords: Laparoscopic, Inguinal Hernia Repair, Technique.


Inguinal hernia repair is one of the most
Table 1: Advantages and Disadvantages of
commonly performed surgical procedures in the
Laparoscopic repair
world. Most surgeons now prefer to perform a

tension-free mesh repair. The Lichtenstein tension-
Advantages [9-11]
free hernioplasty is currently one of the most
Increased cost
popular techniques for repair of inguinal hernias.
postoperative pain
Hernias are abnormal protrusions of a viscus (or
Lengthier operation
part of it) through a normal or abnormal opening in
requirement for
a cavity (usually the abdomen).
They are most commonly seen in the groin; a
Earlier return to work
Steeper learning
minority are para-umbilical or incisional. In the
groin, inguinal hernias are more common than

Higher recurrence
femoral hernias. Laparoscopic inguinal hernia
and complication
repair originated in the early 1990s as laparoscopy
rates early in a
gained a foothold in general surgery[1-4].
surgeon's experience
Inguinal hernias account for 75% of all
abdominal wall hernias, and with a lifetime risk of

27% in men and 3% in women. Repair of these
hernias is one of the most commonly performed

surgical procedures in the world [5].
· Data Sources and Search terms
Even though open, mesh-based, tension-free
We conducted this review using a comprehensive
repair residues the criterion standard, laparoscopic
search of MEDLINE, PubMed, EMBASE,
herniorrhaphy, in the hands of adequately trained
Cochrane Database of Systematic Reviews, and
surgeons, produces excellent results comparable to
Cochrane Central Register of Controlled Trials
those of open repair [6, 7].
from January 1, 1985, through June 15, 2017.
In a comparison between open repair and

laparoscopic repair, Eklund et al. (8) found that 5
· Data Extraction
years after operation, 1.9% of patients who had
Two reviewers independently reviewed studies,
undergone laparoscopic repair continued to report
abstracted data, and resolved disagreements by
moderate or severe pain, compared with 3.5% of
consensus. Studies were evaluated for quality. A
those who had undergone open repair.
review protocol was followed throughout.
Received: 14/10/2017 DOI: 10.12816/0043475
Accepted: 24/10/2017

Full Paper (vol.703 paper# 6)

c:\work\Jor\vol703_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 397-402

Hyperbaric Oxygen Therapy in Plastic Surgery
Abdulelah Ahmed Alwadai1, Abdullah Abdu Haidan Alasmari 2
1. Burn Unit - Aseer Central Hospital, 2. Ahad Rafidah General Hospital

In this review the literature aims to familiarize the reader with several of the more common
plastic surgery problems and to review the appropriate use of HBO for each condition. Plastic surgery is a
broad specialty encompassing a variety of areas including the treatment of traumatic soft tissue injury, burn
care, hand surgery, microsurgery and limb replantation, problem wound management, flap reconstruction,
cosmetic surgery, and congenital deformity. In recent years an emphasis on less anecdotal and more
scientific research has provided a better understanding of the role of hyperbaric oxygen therapy (HBO) for
many plastic surgical conditions. Patient selection remains the key to successful outcome. The rationale for
HBO treatment of a specific plastic surgery problem should be based on scientific research if possible. If
supportive research is not available or applicable to a specific case, then the decision to treat should be
based on sound physiological principles.
Keywords: hyperbaric oxygen, plastic surgery, applications.


The most important effects of hyperbaric
successful, reestablishment of blood flow may
oxygen (HBO), for the surgeon, are the
actually cause accelerated tissue damage due to
stimulation of leukocyte microbial killing, the
reperfusion injury 1.
enhancement of fibroblast replication, and
This is particularly true in cases of limb
replantation in which the reperfused extremity
has a large muscle mass. Muscle is very sensitive
to ischemia-reperfusion (I-R) injury and some
neovascularization in tissue with radionecrosis.
degree of permanent necrosis will occur with
Refractory osteomyelitis and necrotizing fasciitis
ischemia times greater than 4 h.
appear to respond to adjunctive hyperbaric
Concern over use of HBO in the face of 1-R
oxygen. Crush injury and compartment syndrome
injury revolved around the hypothesis that
appear to benefit through preservation of ATP in
providing extra oxygen would increase free
cell membranes, which limits edema. Hyperbaric
radical production and tissue damage. This
oxygen in burn injury permits shorter hospital
concern has been resolved by recent studies
stays, a reduced number of surgeries, and less
which have shown that HBO actually antagonizes
fluid replacement. Skin grafts and flaps are
the ill effects of I-R injury in a variety of tissues 2
reported to take more completely and more
. Evaluation in a rat axial skin flap model of I-R
rapidly. The same mechanisms may apply in
injury has demonstrated that HBO treatment
ischemic problem wounds such as infected
immediately upon reperfusion significantly
diabetic extremities. Contraindications and side
improved skin flap survival following 8 h of
effects are described. Hyperbaric oxygen will not
global ischemia . This finding was opposite this
heal normal wounds more rapidly but may, under
author's original hypothesis that HBO would
certain circumstances, induce problem wounds to
exacerbate reperfusion injury.
heal more like normal ones.Here we will discuss
In a follow-up study the same skip flap model
the role of HBO in different palstic surgery
was used to show that HBO therapy increased
microvascular blood flow during reperfusion
Acute traumatic ischemia
compared with untreated ischemic controls.
High-energy trauma to the extremities may be
Subsequent models of I-R injury have also
associated with major arterial injury or
demonstrated improved blood flow and capillary
compartment syndrome resulting in varying
density with HBO treatment .
degrees of tissue ischemia. Perhaps the most
Studies have shown that HBO treatment
devastating form of acute traumatic ischemia is
during reperfusion significantly improved the
limb amputation.
The primary treatment for these injuries is
microvascular reattachment and ischemia times of
restoration of blood flow in an attempt at limb
up to 24 h. The skin flap studies have been
salvage. Even if surgical revascularization is
corroborated by skeletal muscle experiments,
Received: 14/10/2017 DOI: 10.12816/0043476
Accepted: 24/10/2017

Full Paper (vol.703 paper# 7)

c:\work\Jor\vol703_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 403-408

Evaluation of Topical Monotherapy for Early Primary
Open Angle Glaucoma Patient
Saber Hamed El-Saied, Adel Galal Zaky and Ahmed El-Refaie Ali Abou El-Agha
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Egypt
Corresponding author: Ahmed Elrefaie Ali Abou Elagha, Tel. 01003591336, E-mail: a.zaky12@yahoo.com

: primary open-angle glaucoma is asymptomatic optic neuropathic ocular disease
characterized by enlarging optic disc cupping and visual field loss. World Health Organization estimated
in a systemic review that glaucoma is the second commonest cause of blindness worldwide and topical
ocular hypotensive medication was effective in delaying the onset of open angle glaucoma in individuals
with elevated ocular pressure. Aim of the work: the study aimed to evaluate the safety and pressure-
lowering efficacy of travoprost (0.004%) compared to timolol 0.5% and compared to brimonidine
tartrate 0.2% as monotherapy in patients with primary open-angle glaucoma
Patients and methods: patients were randomized to 3 groups, the first group was received travoprost
0.004%, the second group was received timolol 0.5% and the last group was received brimonidine
tartrate 0.2%. This study was carried out in Menoufia University during the period from January 2016 to
January 2017.
Result: this study included 45 patients who were randomized to 3 groups, the first group received
prostaglandins analogue, the second group received beta blockers and the last group received alpha
agonists. Collected data indicated that the intraocular pressure­lowering efficacy of travoprost was
significantly better compared to timolol and brimonidine at months 3, 6, 9, 12 (P <.001).
Conclusion: using primary monotherapy, the intraocular pressure­lowering efficacy of travoprost
0.004% was superior to timolol 5% and superior to brimonidine tartrate 0.2% in patients with primary
open-angle glaucoma. Travoprost, timolol and brimonidine reduced intraocular pressure effectively in
primary open angle glaucoma.
Keywords: glaucoma, intraocular pressure, prostaglandin analogues, beta blockers, alpha agonists.


Primary open-angle glaucoma (POAG) is
There are five main groups of glaucoma
asymptomatic, progressive optic neuropathic ocular
drugs, each acting in a different way to reduce
disease characterized by enlarging optic disc
IOP and each group may be used as mono
cupping and visual field loss. World Health
therapy or in combinations as the following.
Organization (WHO) estimated in a systemic review
that glaucoma is the second commonest cause of
latanoprost and travoprost) increased uveoscleral
blindness worldwide.
outflow (2).
Elevated intraocular pressure (IOP) caused
Beta-blockers consist of two main groups:
characteristic acquired optic atrophy of the optic
selective (betaxolol) and non-selective (timolol,
nerve and loss of retinal ganglion cell and their
levobunolol), both of which decreased aqueous
axon. Visual acuity is the key player when assessing
production (2).
blindness in developed countries (1).
Alpha-2 adrenergic agonists (apraclonidine,
Topical ocular hypotensive medication was
brimonidine and may open the drainage angle in
effective in delaying or preventing the onset of
angle-closure glaucoma by stimulating the iris
POAG in individuals with elevated IOP. Although
this does not imply that all patients with borderline
production and increased uveoscleral outflow (2).
or elevated IOP should receive medication,
Inhibitors of carbonic anhydrase enzyme
clinicians should consider initiating treatment for
decreased aqueous formation and can be applied
individuals with ocular hypertension who was at
moderate or high risk for developing POAG.
systemically (acetazolamide, methazolamide) (2).
Topical medication was changed and/or added until
Parasympathomimetics (pilocarpine,
both of these goals were met or the participant
carbachol) increased aqueous outflow through
received maximum-tolerated topical medical
the trabecular meshwork by means of ciliary
therapy. Medications were added and changed in
muscle contraction(2).
one-eyed therapeutic trials (1).

Received: 9/10/2017 DOI: 10.12816/0043477
Accepted: 19/10/2017

Full Paper (vol.703 paper# 8)

c:\work\Jor\vol703_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 409-413

Emergency Airway Management in Neck Trauma
Ebtesam Eissa Ali Madkhali1, Sakinah Ali Albati2, Halah Foud Ahmad3,
Soud Mohammad Alzhrani3, Asmaa Yaseen Nassir4, Bassam Mohammed Oudah Albalawi5,
Anas Saleh Heji2, Ali Ghalib Alhashim6, Anas Abdullrahman Alarfaj7,
Amnah Hassan Mansour Alsaffar8, Mohammed Ghazi Alharbi9,
Batool Mohammed Alsadah10, Omar Khalid Alghamdi5, Talal Mislat Alotaibi11
1 Jazan University, 2 Umm Alqura University, 3 King Abdulaziz University, 4 Ibn Sina National
College, 5 Imam Mohammed Bin Saud University, 6 Imam Faisal Bin Abdulrahman University, 7
King Faisal University, 8 Maternity And Children Hospital ­ Dammam, 9 Hera General Hospital, 10
Royal College Of Surgeons In Ireland (RCSI), 11 Majmaah University
Corresponding Author: Ebtesam Eissa Ali Madkhaliebtesam.madkhali@hotmail.com - 0599086554

Airway management in patients who have sustained direct trauma to the airway is among the most
challenging problems for emergency clinicians. Blunt or penetrating injuries to the head, oropharynx, neck,
or upper chest can result in immediate or delayed airway obstruction. Immediate, definitive airway
management is needed when the patient cannot protect his airway or is unable to sufficiently oxygenate or
ventilate. Emergent or urgent airway management is specified when a patient develops respiratory distress or
when symptoms are progressing rapidly. In addition, airway management often is indicated when the patient
appears clinically stable, but the clinician anticipates clinical decline (e.g., smoke inhalation, edema,
subcutaneous air, hematoma) or feels that an unprotected airway presents a risk to the patient who requires
transport to another facility or to radiology for extensive diagnostic studies. The higher rate of complicated
airways in this population mandates that the clinician has to be prepared to use advanced airway techniques,
including a surgical airway.
Keywords: Neck Trauma, Penetrating, Management, Emergency Department.


A clear understanding of the anatomic
injuries and the establishment of a well-conceived
relationships within the neck and the mechanisms
multidisciplinary plan prior to the traumatic event
of injury is critical to devising a rational diagnostic
is critical for improving patient outcome. The neck
and therapeutic strategy. With the neck protected
is divided into anatomic zones or regions to assist
by the spine posteriorly, the head superiorly, and
in the evaluation of neck injuries. The image
the chest inferiorly, the anterior (larynx and
below illustrates the zones of the neck.
trachea) and lateral regions are most exposed to
Ultimately, the goal of airway management in
trauma [1].
trauma is to establish and/or maintain adequate
Few emergencies pose as great a challenge as
oxygenation, ventilation, and airway protection. It
neck trauma. Because a multitude of organ systems
is the first priority in the acute phase of care of the
trauma patient and consists of evaluation and,
gastrointestinal) are compressed into a compact
when indicated, intervention using various
conduit, a single penetrating wound is capable of
techniques and devices.
considerable harm. Furthermore, seemingly
It involves the recognition of any trauma to the
innocuous wounds may not manifest clear signs or
airway or surrounding tissues, anticipation of their
symptoms, and potentially lethal injuries could be
respiratory consequences, and planning and
easily overlooked or discounted.
application of management, keeping in mind the
Neck injury may result in the laceration of
potential for exacerbation of existing airway or
major vessels, potentially leading to hemorrhagic
other injuries by the contemplated strategies. It
shock. Extracranial arterial injuries to the
also involves prediction and prevention of
brachiocephalic, common carotid, and vertebral
progression of airway or surrounding tissue injury
arteries can result in major neurologic deficits [2].
with increasing airway compromise.
Airway occlusion and exsanguinating hemorrhage
Although with certain modifications, the
pose the most immediate risks to life. From the
American Society of Anesthesiologists (ASA)
time when Ambroise Pare successfully treated a
difficult airway algorithm can be applied to
neck injury in 1552, debate has continued about
various trauma-induced airway issues [3], it may
the best approach for particular neck wounds.
not be applicable in some clinical scenarios. For
Awareness of the various presentations of neck
instance, cancellation of airway management when

difficulty arises may not be an option in the acute
Received: 15/10/2017 DOI: 10.12816/0043478
Accepted: 25/10/2017

Full Paper (vol.703 paper# 9)

c:\work\Jor\vol703_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 414-418

Laparoscopic Surgery Compared to Open Surgery in Excision of
Rectal Cancer: A Systematic Review
Saud Abdulaziz Musa Alqahtani, Abdulsalam Siddiq Mohammed Arishi, Meshal Salem Ahmed
Bajoned, Meshari Fahad Abdullah Alasmari, Moath Abdullah Yahya Qadri, Mohammad Abdallah
Yahya Alhakamy, Ahmad Sameer Ahmad Alrefaie, Alalaa Hussain Othman Hakami
Faculty of Medicine, Jazan University, Saudi Arabia
*Corresponding author: Saud Abdulaziz Musa Alqahtani, E-Mail: dr.expert333@gmail.com

The laparoscopic surgery for rectal cancer, such as open surgery, is associated with many
surgical complications, especially if the surgeon does not have sufficient experience in open total
mesorectal excision and advanced laparoscopic surgery. This review aiming at comparing the effectiveness
and the complications rate of laparoscopic surgery to those of open surgery.
The comprehensive electronic search was conducted in Medline and Embase databases. The
search resulted in 102 relevant clinical trials, which were subjected to primary screening and exclusion of
ineligible studies. Finally, 32 potentially relevant clinical trials were included in the secondary screening
from which nine clinical trials were included in this review. Data were collected from included studies
using data extraction forms, then the qualitative synthesis of extracted data was conducted.
Small differences between interventions were reported by the included studies. Five-years survival
rates tend to be slightly higher in the open surgery, whereas 3-years survival rates were higher in the
laparoscopic surgery. It be attributed to the wider safe margin for tumor excision obtained in open surgery.
The complications rates were slightly lower in the laparoscopy groups among most of the included studies.
This review found comparable outcomes of laparoscopy and open surgery in treatment of
rectal cancer with minimal differences in survival and complications rates.
Keywords: Rectal cancer; Laparoscopic; Open Surgery; Survival; Death.


Rectal cancer is one of the common
of the autonomic nerves and sphincter apparatus
digestive tract tumors(1).
are important to maintain bladder,
World widely, colorolorectal cancer is the
sexual function and continence, which represent
third most common neoplasm and approximately
important aspects of quality of life after surgery (5).
1.4 million new cases and 694,000 deaths reported
Laparoscopy, as a surgical intervention, has
every year. Approximately one third of all
identified as the treatment of choice of many
colorectal cancers are localized in the rectum(2).
digestive diseases, including benign colorectal
Surgical operation is the first-choice method to
pathologies. However, the oncologic safety of this
treat rectal cancer(1).
approach still is controversial, so laparoscopic
Multicenter studies and meta-analyses
methods have been less widely applied to
comparing laparoscopic with open surgical
colorectal malignancy (6).
treatment of colonic cancer have demonstrated
An open surgery as a laparotomy has to be
short-term advantages for the laparoscopic
performed and closed, as well as closure of the
approach, including less postoperative pain, rapid
perineal wound. Despite the longer operating time,
recovery of intestinal function and short length of
most studies report a shorter hospital stay for
hospital stay, but similar long-term oncological
patients having laparoscopy (7).
outcomes and survival(3).
Laparoscopic surgery for rectal cancer,
However, less is known about the role of
such as open surgery, is associated with many
laparoscopy in rectal cancer surgery, where
surgical complications, especially if the surgeon
outcomes are more closely linked to the surgical
does not have sufficient experience in open TME
technique for several reasons(4). First, the
and advanced laparoscopic surgery (8).
anatomical position of the rectum makes access
This review aiming at comparing the
more difficult; second, total mesorectal excision
effectiveness and the complications rate of
(TME) is important for reducing local recurrence
laparoscopic surgery to those of open surgery.
and improving survival; and, finally, preservation

Received: 17/10/2017 DOI: 10.12816/0043479
Accepted: 27/10/2017

Full Paper (vol.703 paper# 10)

c:\work\Jor\vol703_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 419-425

Effect of Different Fluoridated Mouth Rinses on the Surface
Characterization of Nano-filled Resin Composite Materials
Aram Soliman Alnoury, Sarah Ayman Barzanji, Ahmed Soliman Alnoury
Faculty of dentistry, King Abdulaziz University
*Corresponding author: Aram Soliman Alnoury, E-Mail: dr.expert222@gmail.com

The influence of recently marketed fluoridated mouth rinses on the surface roughness of the
newly nano-filled composite resins has not yet been adequately investigated.
Objectives: This study aiming at evaluating the effects of different types of mouthwashes on surface
roughness of different types of composite resins.
Materials and Methods: This experimental in vitro study included 3 types of mouthwashes (Colgate Plax,
Listerine, and Aloe Dent) and 3 types of composite resins (Z350, Z250, and Art). Six specimens were
prepared for each material in each group. All specimens were fabricated at room temperature 23°C. Pre-test
measurements were recorded for all specimens in the three test groups using the profilometer after storing all
specimens in distilled water for 24 hours. Post- test measurements were recorded after storing each specimen
for 1 minute/day for 1 week. Means and standard deviations were calculated and the differences in means
(before and after) between the tested groups were performed using Paired Sample t-test with p value <0.05 as
a significant level.
Results: The pre-test means and SDs for the tested groups according to the type of mouthwash were
140.7±53.86 for group B, 159.63±44.34 for group C, and 166.55±51.16 for group D. The after-test readings
were 158.42±47.63, 176.11±49.30, and 171.49±31.81 for the same group, respectively. The highest difference
in means between before and after measurements was found in group B with a value of 17.73±10.82 with
high significant level (P <0.001). The difference in means for group C was 16.48±8.42 which was also highly
statistically significant (P <0.001). The lowest difference, however, was found between the means in group D
with a value of 4.94±48.22 with no significant level (P >0.05).
Conclusion: Among the tested storage mouth rinses, Aloe Dent was found to have the least effect on surface
Keywords: Mouth rinse; Fluoridated; Composite; Nano-filled; Surface Roughness.


formulation of these mouthwashes consists of
The introduction of composite-based resin
water, antimicrobial agents, salts, and in some
technology to restorative dentistry made a huge
cases alcohol, and the different concentrations of
difference in oral health in different ways. In
these substances can affect the pH of
addition, it has been used as liner and base-bonded
mouthwashes(9-11). In addition to conventional
restorations and has the potential for tooth repair
with less of use of tooth material. Composite resin
containing hydrogen peroxide have been
has an organic binder and an inorganic filler in
marketed. However, in this case, besides hydrogen
such a way that can induce polymerization
peroxide at low concentration, these mouthwashes
reaction upon stimulation. Altered size and filler
contain alcohol in their composition. In addition,
loading has improved the wear resistance of early
some side effects of mouth rinses have been
composite resin restoration. Also, achieving
reported on the surface roughness of the composite
surface smoothness for a restoration is vital for its
resinbecause it contains acidic solutions that may
success(1,2). There are many factors cause surface
cause changes in the organic composition of resin
roughness and hardness of the composite resin.
composites (12). In the last few years their use has
Some factors are related to the dentists and clinical
attracted the curiosity of the researchers because
procedures and materials used and other factors
of their ability to modify the surface of composite
are related to the patient and homecare means of
resins. Some studies have shown that these
the restorations (3-6).
products with and without alcohol can affect the
Mouth rinses have been used for centuries
hardness of composite and have become a possible
for the purpose of providing oral health and
threat to oral health (13) because surface
cosmetic benefits(7), to prevent and control caries
smoothness of the restoration is vital for its
and periodontal diseases, and are frequently used
success (13,14); and if the restoration surface is
even without professional prescription (8). The
rough, it will contribute to the deposition of dental
Received: 18/10/2017 DOI: 10.12816/0043480
Accepted: 28/10/2017

Full Paper (vol.703 paper# 11)

c:\work\Jor\vol703_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 426- 429

The Awareness of The Risk of Chronic Use of Steroid Causing
Cataract in Tabuke City, Saudi Arabia,2017
Al Khozym Saeed Ali A
Tabuk university
Cataracts could result in very dangerous consequences including worldwide blindness which
imposes a great economic burden on people and health authorities.
Objectives: Evaluate the knowledge of Saudi subjects in Tabuk City toward the cataract induced by chronic
use of steroids. Methods: It is a cross sectional community survey based on a questionnaire sheet that was
carried out among sample of adult subjects from different shopping malls, community pharmacists, coffees
and masjids of Tabuk City from July to September 2017.
Results: All the subjects have already heard about cataract and only 6.4% of them suffered from cataract.
The most common source of knowledge among participants were relatives and friend (75.1%). Only 9.1% of
the subjects used steroid therapy for long periods as 59.4% of them used topical steroids, followed by 20.3%
by oral therapy. Most of the subjects (81.4%) showed inadequate knowledge about the steroid induced
cataract. The older age had significant association with good knowledge.
The level of knowledge about risks factors of chronic usage of steroid therapy and its effects on
cataract was inadequate among most of the subjects, although they were university graduates.
Keywords: Knowledge, Cataract, Chronic Steroid Therapy, Tabuk City.


The natural lens looks like a crystalline
usage of steroid therapy on cataracts that
substance with specific structure of protein and
necessitate urgent need for future studies in KSA to
water to allow clear passage of the light. Cataract is
increase the awareness and prevent the occurrence
an opacity of the inside lens of the eye that result in
of cataract. This study evaluated the knowledge of
deterioration of the vision due to reduction of the
Saudi subjects in Tabuk City toward the cataract
amount of incoming light thus it is described as
induced by chronic use of steroids.
looking waxed paper (1).

Cataracts could result in very dangerous
consequences including worldwide blindness as
Study design
about 51% of blindness in the world are due to
It is a cross sectional community survey
getting older (2). Cataract induced blindness
based on a questionnaire sheet.
imposes a great economic burden on people and
health authorities hence prevention of cataract risk
The study was carried out among sample of
factors could result in modifying the rates of
adult subjects from different shopping malls,
surgeries by about 45% and decreasing the
community pharmacists, coffees and masjids of
prevalence of cataract (3, 4).
Tabuk City from July to September 2017.
Recently, corticosteroids are globally used
Study population
for various medical diseases and conditions thus
The study included adult Saudi subjects
increased the complications related to their uses
who are educated and aged from 20-60 years old.
including ocular diseases such as cataract,
Sample size
glaucoma and a global burden for ocular
The number of Saudi population aged from
impairment (5, 6). Also, steroid therapy is defined as
20-60 years old in Tabuk City was issued by the
the fourth chief risk factor for secondary cataract
General Authority for Statistics (GAS), KSA in
that represents about 4.7% of all cataract around the
2016 (12). The minimum recommended sample size
world (7, 8). Chronic and high potency use of
that was calculated using the web calculator(13)was
384 subjects with a margin of error of 5% and a
corticosteroids could significantly induce ocular
95% confidence interval. The sample size was
cataracts (9, 10). The use of chronic steroids for
doubled to achieve 50% response rate and to avoid
allergic and atopic contact dermatitis necessitate
the incomplete data.
long-term therapy for management thus, may
Study tools and data collection
increase the risks of cataract and glaucoma
This study included a questionnaire sheet that was
induction especially in elderly (9, 11). There is a lack
conducted after reviewing all the available English
of knowledge toward the impacts of long-term
studies that include researches about steroid
Received: 20/10/2017 DOI: 10.12816/0043481
Accepted: 30/10/2017

Full Paper (vol.703 paper# 12)

c:\work\Jor\vol703_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 430-435

Anterior Technique in Spinal Deformity Correctional Surgery
1 Khalid Mohammed Yahya Mania, 1 Khamis Abdu Khamis Khamis,
1 Abdulwadood Muhammed Yahya Hefdhi, 2 Fahad Mousa Mohsen Maashi,
1 Mohammad Hassan Ali Haroobi, 1 Abdulrahman Yahya Ahmad Alqasem
1 Faculty of Medicine, Jazan University, 2 King Fahad Central Hospital, Jazan

The aim of this review is to classify spinal deformities, provide knowledge in correctional surgery of spinal
deformities and highlight the anterior technique. PubMed and Medline database search was performed for
published articles up to October 2017 related to surgical techniques for spinal deformities. Spinal deformity may
be the pathology of one vertebra or may develop with pathologies of multiple vertebras, ribs or the pelvis. The
spine must be analyzed in different planes before starting the treatment because it can be accompanied by
multiple organ pathologies. Different surgery types can be used and anterior method is one of them, which can
give better result in cases with advanced kyphosis. The therapy of serious spinal deformity is challenging and
needs a careful analysis of the patient by the orthopedic surgeon, anesthesiologist, pulmonologist, and
neurologist especially when neurologic deficits are existing.
Keywords: Anterior Technique , Spinal Deformity.


The vertebral column is an accumulation of
scoliosis by traction as well as counter-Traction on
articulated, superposed segments, each of that is a
his bench, and also Ambroise Paré, in
functional system. The function of the vertebral
the 16th century, was attributed with explaining
column is to support a person in upright placement,
the 1st use supporting to deal with scoliosis. The
mechanically equilibrium to satisfy the stress and
standard approaches to therapy throughout the ages
anxiety of gravity, allow mobility as well as aid in
have actually included traction, support and also
deliberate activities [1].
essentially strenuous redressing plus workout and
The head lies over the body of the sacrum, and
also massage therapy. In 1911, Hibbs et al. [4], as
also the vertebrae in an upright way carries an axial
well as Albee et al. [5], presented their spine fusion
load to hold the human body. Loss of this vertebral
for tuberculosis of spinal column, then fusion
equilibrium creates a placement that goes to a
approach was used for scoliosis management.
biomechanical negative aspect. To stand upright and
Nonetheless, there was no constant progression in
also look ahead while standing and also strolling, the
the management of vertebral defect up until 1945
patient with sagittal plane discrepancy creates back
when Smith-Petersen [6] presented a spine
muscle to stress to efficiently or unsuccessfully
osteotomy treatment which was customized by the
minimize a patient's sideways tilt [2]. The added
numerous specialists. One negative aspect for
power expense related to standing and strolling in
surgeons at the time was that interior fixation tool
the patient with a spine defect causes lowered useful
for the osteotomy was not readily available. In 1955,
capability consisting of lung function and also a
Harrington presented the hooks as well as poles
poorer lifestyle.
system which revolutionized the defect improvement
The description and also range of vertebral defect
surgical treatment. Halo disturbance device,
remains to develop. Definitely, the term spine defect
established by Nickel and Perry in 1959 could be
consists of problems such as idiopathic adolescent
used for a seriously flawed as well as stiff spinal
scoliosis, congenital scoliosis, post-traumatic defects
column [7].
and also various other grown-up vertebral defect
Spine is one the most important structure in the
consisting of post-infective kyphosis. In our
anatomy of the human body that provides balance.
community, among one of the most typical extreme
The aim of this review is to classify spinal
defects is the post-infective kyphosis specifically in
deformities, provide knowledge in correctional
the much less privileged places [3]. In old times,
surgery of spinal deformities and highlight the
Hippocrates and also his followers dealt with
anterior technique [8].

Received: 21/10/2017 DOI: 10.12816/0043482
Accepted: 1/11/2017

Full Paper (vol.703 paper# 13)

c:\work\Jor\vol703_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 436-438

Primary Giant Cell Tumor of Soft Tissues: A Case Report and
Literature Review
Furat Abdulrahman Almayouf
College of Medicine, Qassim University, Saudi Arabia
Corresponding author: Furat Abdulrahman Almayouf, Phone: +966546848999, E-Mail: Forat.a.m@gmail.com

Giant cell tumor of soft tissue (GCT-ST) is a rare tumor of low malignant potential. Grossly and
histologically similar to its bone counterpart. Majority has benign clinical course and rarely metastasizes.
This is a case of a 46-year-old woman with a giant cell tumor of soft tissue of the knee. This tumor was not
suspected clinically and was initially diagnosed as septic infra-patellar bursitis. The diagnosis of GCT-ST
was made after histopathological examination. Herein, we describe the clinical, histologic, and
immunohistochemical features of this rare neoplasm.
Keywords: Giant cell tumor of soft tissue; Giant cell tumor of bone; giant cell rich soft tissue neoplasms.


Primary giant cell tumor of soft tissue
bursitis. MRI show well defined soft tissue lesion
(GCT-ST), also known as soft tissue giant cell
with no bony destruction. An excisional biopsy
tumor of low malignant potential (GCTST-LMP)
was subsequently performed and the histologic
(1), was first described in the literature by Salm
features were compatible with the diagnosis of
and Sissons (2) in 1972, a case series of 10 primary
primary GCT-ST. Postoperatively, the patient
soft tissue tumors that run a relatively benign
symptom free and in good health.
clinical course although some exhibit local

recurrence. However, Guccion and Enzinger (3) in
Pathological finding
same year reported a 32 case series with two
On gross examination, the excisional
distinct variants, a largely benign and a few
biopsy revealed a well circumscribed oval firm to
having low malignant potential. This type of
hard mass of grey tissue measuring 3 x 2 x1 cm.
tumors occurs in a broad age range with no sex
Cut section shows cystic lesion with grey white
predilection (4, 5). The main presenting feature was
tissue along with bony tissue.
a painless growing mass (4). GCT-ST, is a
Microscopically, sections reveal well
relatively rare entity, and is clinically and
histologically similar to its bone counterpart (2, 3).
fibrocollagenous tissue, bone trabeculae enclosing
This rarity makes it difficult for clinicians to
hypocellular marrow spaces. Towards the center,
diagnose accurately before biopsy, resection of
rim of metaplastic bone/osteoid tissue formation
tumor (6, 7). Herein, we report a rare case of GCT-
is seen. Center of the lesion is formed of
ST with comprehensively review 72 cases of
proliferative small to medium cells having rather
GCT-ST that have been reported in the English-
bland plump oval/spindle nuclei, inconspicous
language literature (3, 4, 8).
nucleoli, ill-defined cytoplasm with mitotic rate

up to 1-2/HPF in the most active areas but no
atypical mitosis and no significant cellular atypia.
A 46 -year-old woman was admitted to
Numerous scattered osteoclast-like giant cells
King Saud Hospital in Qassim region for
(figure 2), focal tiny hemorrhage are seen. No
evaluation of a 2-months history of painful
necrosis in examined section.
swelling and restricted movement in her left knee.
Immunohistochemical stains for vimentin,
The patient denied any direct trauma on this area.
smooth muscle actin (SMA), CD68, Ki67 were
The clinical diagnosis was septic infra-patellar

Received: 19/10/2017 DOI: 10.12816/0043483
Accepted: 29/10/2017

Full Paper (vol.703 paper# 14)

c:\work\Jor\vol703_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 439-445

Early Epinephrine Administration in Patients with Cardiac
Arrest in Case of Shockable Rhythm in ER
1Khalid Yahya Alzahrani, 1Abdulaziz Saud Alghamdi, 1Omar Hussain Alghamdi, 2Yasser
Musallam Alrehaili, 3Mahmoud Shehab Halawani, 4Saleh Jameel Almatrafi, 4Abdulkareem
Khaled Almotairi, 5Bayan Jamal AlMulhim, 6Naif Khaled Alomar, 7Aman Abdullah Alkishi,
8Abeer Abdullah Alreshidi, 9 Basil Mohammed Alrajhi
1King Abdulaziz University,2King Fahad Hospital,3Ohud Hospital,4Ibn Sina National College
5King Faisal University, 6Imam Mohammed Bin Saud Islamic University,7Alfaisal University
8International Academy for Health Science, 9 Albatterjee Medical College, SA

The objective of the review was to investigate the scientific production and evaluate the effectiveness of
epinephrine in the treatment of cardiac arrest in terms of survival and neurological status. PubMed, Embase, and
Google Scholar databases were searched up till November 2017 for published studies in English language and
human subjects discussing early epinephrine administration in patients with cardiac arrest in case of shockable
rhythm in emergency medicine. Prehospital epinephrine management may increase short-term survival (ROSC)
yet does not improve survival to release, or neurologic results after out-of-hospital cardiac arrest OHCA.
Although there is no clear proof of long-lasting advantages complying with the use of epinephrine in OHCA,
there is insufficient evidence to sustain altering present guidelines which recommend its management (1 mg
every 3-5 min) throughout resuscitation. As a result, there is a need for additional clinical trials to analyze
whether lower dosages or alternative regimes of epinephrine administration. Furthermore, one of the most
important aspects of care in cardiac arrest is basic life support (BLS) measures, consisting of adequate
compressions and early defibrillation.
Keywords: Epinephrine , Cardiac Arrest , Shockable Rhythm.

suggested that regulated clinical trials of vasopressors
The cardiorespiratory arrest is the sudden and
vs. placebo are required. With the present proof, the
unexpected cessation of breathing and spontaneous

circulation, that can be restored to a previous
use of epinephrine in cardiac arrest is advised as class
condition, in those in whom a deadly outcome was
IIb [4]. This needs to be thought about, as the
not anticipated back then [1].This is a major issue
advantages could exceed the dangers; consequently,
worldwide because the occurrence is approximated at
both organizations recommend using 1 mg of
around 55 out-of-hospital cardiac arrests in adults
epinephrine every 3-5 min. Nonetheless, AHA has
every 100,000 individuals, of whom only 7% survive
indicated that 40UI of vasopressin could change the
[2]. As concerns in-hospital cardiac arrests, pertinent
very first or 2nd dose of epinephrine [5].
searching for in the literature were scarce, but
estimates suggest that the occurrence could be
catecholamines, together with norepinephrine and
between 1 and 5 situations each 1.000 admissions
dopamine, that has a potent stimulatory activity on
each year, and the total survival ranges 10% and 42%
and receptors distributed throughout the body; in
the heart raises the circulation rate, the heart rate and
The treatment of cardiorespiratory apprehension
the force of tightening (chronotropic and inotropic
follows suggestions released every 5 years, based on
results on the heart) therefore raises the quantity per
a variety of reviews by the International Liaison
minute, the systolic blood pressure and at the same
Committee on Resuscitation (ILCOR), a company
time the myocardial oxygen intake. High dosages
developed by leading international councils and
generate extrasystoles and cardiac arrhythmias; they
Resuscitation associations. Exceptional amongst them
(high doses) also produce a surge in high blood
are the American Heart Association (AHA) and
pressure (especially diastolic) that assists in venous
European Resuscitation Council (ERC). Both AHA
return and ventricular filling during diastole by
and ERC suggestions, from 2010 and 2015, have
boosting and receptors. This raises overall outer
resistance, thus triggering a boost in differential
Received: 16/10/2017 DOI: 10.12816/0043484
Accepted: 26/10/2017

Full Paper (vol.703 paper# 15)

c:\work\Jor\vol703_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 446-451

Narrative Review on Different Clinical Aspects of Thrombocytopenia
1Abdulaziz Saud Alghamdi, 1Khalid Yahya Alzahrani, 1Omar Hussain Alghamdi,
1Abdulraouf Muhammad Altaleb, 1Majed Abdulaziz Mauqary, 2Saleh Ibrahim Alrufayyiq,
2Faisal Fahad Alanizy, 3Olfa Ahmed Halawani, 4mohammad Hamdin Alhasnani,
5Yasser Musallam Alrehaili, 6abdullah Mahmoud Aldor
1king Abdulaziz University,2king Saud Bin Abdulaziz University For Health Sciences,
3Ibn Sina National College, 4Umm Al-Qura University, 5King Fahad Hospital,6October 6 University

This review article aims to summarize the major causes of thrombocytopenia and characterize the main
general symptoms of thrombocytopenia. As well we summarize the diagnosis and treatment methods. We
conducted the search using electronic biomedical databases such as; Medline, and Embase, for studies published
up to September 2017 in the English language concerning the thrombocytopenia in general. Thrombocytopenia
can either be primary or secondary, in that it could go along with a broad spectrum of syndromes and diseases
and may be triggered by different systems. Trigger investigation and recognition might be important and
sometimes life-saving as in TTP, heparin-induced thrombocytopenia, acute leukemia or perhaps severe ITP.
Taking a detailed history and a thorough physical examination can give clues concerning possible underlying
illness and clinical treatments. Cautious evaluation of the peripheral blood smear is necessary. When the
differential diagnosis is problematic, sometimes a short trial of therapy could help to clarify the reason. For
instance, it might be difficult to differentiate inherited thrombocytopenia (without a family history) from
immune thrombocytopenia (ITP); in this example, intravenous immunoglobulin infusion will likely have no
effect in inherited thrombocytopenia, however, will generally be useful in ITP.
Keywords: Clinical Aspects, Thrombocytopenia, intravenous immunoglobulin infusion.


Although lots feel that a cutoff value of 100 ×
or moderate thrombocytopenia. Although the cause
109/L is better suited to identify clinically
is unidentified, it should be carefully evaluated from
other major causes of thrombocytopenia [3].
thrombocytopenia can be subdivided into lowered
This review article aims to summarize the major
platelet production, increased platelet damage,
causes of thrombocytopenia and characterize the
increased splenic sequestration, and dilution. The
main general symptoms of thrombocytopenia. As
investigation requires a point to consider patient age,
well we summarize the diagnosis and treatment
baseline platelet count, medical and surgical history,
including any kind of bleeding or thrombotic

symptoms, family history, medication history,
outcomes of any relevant laboratory testing, and
· Data Sources and Search terms
health examination findings. A complete blood count
We conducted this review using a comprehensive
(CBC) and peripheral smear testimonial are crucial
search of MEDLINE, PubMed, EMBASE, Cochrane
for first analysis. Ethylene diamine tetraacetic acid
Database of Systematic Reviews, and Cochrane
Central Register of Controlled Trials up till
laboratory artifact defined by in vitro platelet
November 2017 for published studies in English
clumping in EDTA anticoagulant, need to be omitted
language concerning the thrombocytopenia in
[1]. The spleen harbors 30% of the overall platelet
general, Following MeSh terms were used in our
search strategy: "thrombocytopenia, pathogenesis
thrombocytopenia due to platelet sequestration.
and platelets disorders. More relevant studies were
Dilutional thrombocytopenia is seen after the
searched for in the references list.
significant surgical procedure or with transfusion of
· Data Extraction
large amounts of non-platelet-containing blood
Two reviewers independently reviewed studies,
abstracted data, and resolved disagreements by
thrombocytopenia in pregnancy is identified by mild
Received: 16/10/2017 DOI: 10.12816/0043485
Accepted: 26/10/2017

Full Paper (vol.703 paper# 16)

c:\work\Jor\vol703_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 452-457

Assessment and Evaluation of the Quality of Life of Saudi Patients
Underwent Coronary Artery Bypass Graft (2-5 years)
Thamer Menwer Albilasi, Bader Menwer Albilasi, Mushari Aber Alonazi, Waleed Sultan Al-ruwaili,
Markhan Hammad Almarkhan, Nafea Hamoud Alanazi
Al-jouf University, Collage of Medicine
Corresponding author: Thamer Menwer Albilasi, Email:albilasith@gmail.com, mobile: 00966503752513

Cardiovascular disease (CVD) is a cluster of diseases that involve heart and blood vessels (10).
They also include coronary heart disease (CHD), coronary artery disease (CAD), and acute coronary syndrome
(ACS). This paper aimed at measuring the quality of life after coronary artery bypass graft procedure and
determine the factors that affect the quality of life.
Methods: Data was collected via a structured close-ended questionnaire in which 100 (male and female, aged
40-60) were questioned. Patients were chosen after underwent CABG surgery 2 to5 years.
Results: Carried out as good 36% for their general heath and 24% very
good. The activities indicated that there was a significant difference between males and females. Moreover,
female participants were significantly different from male (P. value <0.05) in their perception towards own
health. Elder participants (56-60 years) were feeling better in comparison with middle age (40-49 years), (P.
value 0.002). Conclusion and recommendations: The core domains related with the quality of life, that
affected are physical functioning, bodily pain, social functioning and emotion, Therefore, health care
specialists must plan for interventions towards improving the HRQOL to decrease the complications of CABG
surgery. We recommend the establishment of a special center for rehabilitation of patients underwent CABG.
Moreover, providing a further minimal invasive procedure to improve HRQOL.
Keywords: Coronary Artery Bypass Grafting, Quality of life, Lifestyle.


artery (IMA) grafting has been documented to have
Cardiovascular disease (CVD) is a cluster of
the most profound beneficial effect (26,3). In recent
diseases that involve heart and blood vessels (10).

They also include coronary heart disease (CHD),

coronary artery disease (CAD), and acute coronary
years, there has been considerable interest in the
syndrome (ACS). CAD is categorized by
negative impact of depression on outcomes among
atherosclerosis in coronary arteries; it can be
patients with coronary heart disease (CHD) (14).
asymptomatic, where ACS almost always shows
Equally important, quality of life is a mark of quality
with a symptom (1).
of health care and it is kind of treatment program.
CHD is considered to be a main cause of death
Measuring quality of life in chronic diseases affords
and disability in developed countries (18). CAD may
more evidence for the treatment team about patients'
lead to myocardial infarction; heart failure. The risk
health status (11,9).
aspects for CAD include diabetes, hypertension,
Most of the studies focus on health-related quality
obesity, smoking and higher cholesterol level (17).
of life (HRQOL) following CABG, which is a key
Coronary Artery Bypass Graft (CABG)
measure of operative success (5).
surgery is considered as an effective treatment
choice for patients with coronary artery disease. (7).
The aim of the study was to measure the quality
219,000 CABG surgeries were done in the United
of life after coronary artery bypass graft procedure.
States, in 2010(8).
It seeks to determine the factors that affect the
CABG has showed incremental developments
quality of life.
in improving outcomes, since its commencement in
the 1960s (28), the use of in situ internal mammary
This is a cross-sectional community-based study
of a qualitative approach. The study enrolled 100
Received: 24/10/2017 DOI: 10.12816/0043486
Accepted: 4/11/2017

Full Paper (vol.703 paper# 17)

c:\work\Jor\vol703_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 458-463
Type 1 Diabetes Mellitus among Adolescent Girls in
Riyadh City, Saudi Arabia
Khulud Falah M Alanazi1, Najah Salah F Alanazi1, Mona Salah F Alanazi1,
Abdurhman Aiash Alrwaili1, Bader ArarShadad Alruwaili1, Abdulaziz Ayad ALanazi1,
Maram Khalf Ayad Alenzi1, Bdoor Attaulla Alenezi1, Safiah Bader Al-Eid2,
Manal Nashi Alshammari1, Naif Salem Alshammari1, Aishah Mohammad Alkhaldi1, Matar
Mohammed Alharbi3

1Northern Border University, Arar, 2Imam Abdulrahman bin Faisal University, Dammam, 3Alfaisal
University, Riyadh, KSA

Diabetes mellitus (DM) is rapidly becoming one of the main health issues among humans
in the 21st century. The increase in the incidence of type 1 diabetes has been observed as a global public
health problem in children and adolescents. This work was conducted aimed to estimate the prevalence
of type I diabetes and to describe some related characteristics of cases in a sample of adolescent primary
and secondary school girls of Riyadh city, KSA. Methods: A cross-sectional study was conducted
during the academic year 2016-2017. Data were collected via a predesigned and pretested questionnaire
to gather the relevant data. The total number of participants was 154 adolescent girls. Results: The
overall prevalence of type I diabetes among the studied adolescent girls was 5.2% with Mean(±SD) age
was 14.08 (± 3.4). All diabetic girls were Saudi. Only 25% of the cases were using a hormonal
contraception. No smoking history or other chronic diseases was detected among them. Conclusion: The
present study establishes the prevalence of type 1 DM among Saudi adolescent girls to be 5.2%. We
suggest repeating this study periodically, with concentration on the various possible etiological and risk
factors. Also we recommend conducting similar studies in other areas of Saudi Arabia to get more
information about Diabetes. Awareness campaigns and continuous medical education is of utmost
importance to detect the disease to guard against development of complications.
Type 1 diabetes mellitus; Adolescent Girls; Riyadh City; Saudi Arabia.

common compared to type 2, it is still increasing
Type 1 diabetes mellitus (T1DM) is
by around 3% every year, particularly among
caused by insulin shortage because of
children and adolescents [5]. Saudi Arabia, a
autoimmune disease destroying the beta cells

of the pancreas. The emergence of diabetes
country of almost 30 million population of
mellitus as a global public health problem in
which 26% are under 14 years old, ranked the
children and adolescents is due to the
7th globally in number of children with T1DM
widespread obesity and pronounced lifestyle
[6]. A nationwide Saudi Arabian project was
changes [1]. It can occur at any age, but tends to
conducted in the years 2001-2007 with the
develop in childhood [2], so it has long been
objective of establishing national growth charts,
called "juvenile diabetes". In the past, type 1
and defining the prevalence of some chronic
diabetes used to be the predominant type among
childhood diseases such as diabetes mellitus.
children and It was called juvenile diabetes. For
45,682 children and adolescents were surveyed.
the last 20 years, type 2 diabetes [3, 4] which is
Fifty children and adolescents were identified to
known for its different etiology, is taking the
have type 1 diabetes mellitus with a prevalence
lead. The trend toward more children developing
rate of 109.5 per 100,000. The male to female
T1DM has continued and as of 2015, more than
ratio was almost equal (26 males and 24
half a million children are estimated to suffer
females) [7]. T1DM squeal in children and
from type 1 diabetes. Whilst T1DM is much less
adolescents involve acute complications such as
Received: 23/10/2017 DOI: 10.12816/0043487
Accepted: 3/11/2017

Full Paper (vol.703 paper# 18)

c:\work\Jor\vol703_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 464-468

Association between Cretinism and Prolactin Secretion
Omar Ahmad Almontasser Al-khayari 1 , Hebah Adel Mansour 2 , Safiya Ali Ahmed lotfallah 3 ,
Sulaiman Abdullah Alawaji 4 , ABDULRAHMAN BADER ALHARBI 4 , Sarah Abdulaziz Hamid
Fallatah 5 , Ahmed Abdullah Ahmed Bahatab 6 , Fahad Yahya Ahmad Hakami 7 , Anouf Fawzi Enani 8 ,
Hafsa Ibrahim Bilal 9 , Fatimah Shafiq Al-Mubarak 10 , Rami Mohammed Hamed Almutairi 11
1- Imam Mohammed Bin Saud University, 2- Jeddah Eye Hospital, King Abdulaziz University,
3- Beirut Arab University , 4- Qassim University , 5- GP King Abdulaziz Hospital Jeddah , 6- Saudi
National Hospital , 7- Sabia PHC , 8- Prince Sultan Primary Health Care , 9- Batterjee Medical College ,
10- PHC in Al-Khober , 11- *Ohud* Hospital Medina

To compare the serum prolactin level in hyperthyroid and normal control females. Hyperthyroidism
is a mutual disease. Even though a direct relation has been demonstrated amid hypothyroidism and increased
prolactin levels, this association has not been established for hyperthyroidism.
Materials and Methods: Cross sectional study was carried out on cases and control groups. To select the
cases, all women referred to the laboratories of Saudi National Hospital with a thyroid-stimulating hormone
(TSH) level 0.5 mIU/L and met the inclusion criteria were entered in the study. A total of 62 women aged 16
to 49 years were enrolled. The case group included 24 hyperthyroid women, and the control group included 38
women with normal thyroid function matched by age.
Results: The mean (SD) serum level of prolactin was 16.4 (0.96) ng/mL (95% confidence interval [CI], 15.39
ng/mL to 15.69 ng/mL) in the controls and 23.02 (1.47) ng/mL (95% CI, 22.7 ng/mL to 23.4 ng/mL) in the
case subjects. Hyperprolactinemia was more common in the hyperthyroid group (16.4 [0.96] ng/mL versus
23.02 [1.47] ng/mL; P<.001). The prolactin level decreased with age. Hyperthyroidism and estradiol increased
the prolactin level. After adjusting for age and estradiol, hyperthyroidism increased the serum prolactin level
Conclusion: The outcomes of the present study showed that hyperprolactinemia is more frequent in
hyperthyroid females. Serum prolactin level can be increased in hyperthyroidism.
Keywords: Prolactin secretion, hyperthyroidism, Hyperprolactinemia.

thyrotropin-releasing hormone (TRH) level[1].
Prolactin (PRL) is a lactogenic hormone secreted
Nevertheless, the direct influence of hormones on
by the anterior pituitary. Hyperprolactinemia is a
serum PRL levels and the association amid
case where the baseline or fasting level of PRL in
hyperthyroidism and PRL is uncertain[2,3], as
the morning and in the absence of pregnancy and
thyroxine (T4) did not alter prolactin level in other
lactation is >25 ng/mL [1]. PRL levels begin to
studies[4,5]. PRL levels in chronic hyperthyroidism
increase as a result of a range of reasons,
was found to be normal or marginally above normal
comprising the following:
[6,7]. Even though PRL production increases in
Physiologic reasons (sleep, exercise, physical stress,
hyper- and hypothyroidism, as a result of increased
emotional stress, breast stimulation, and high-
clearance in hyperthyroidism, an elevated blood
protein diet);
level of PRL was found in patients with
In hypothyroid patients and patients with chronic
hypothyroidism[8]. Baseline PRL levels in
kidney and liver diseases;
hyperthyroid patients were higher than in normal
In patients with prolactinomas, destructive lesions
subjects[9]. One of the significant points regarding
of hypothalamus or pituitary stalk;
thyroid hormones is their contribution in the
Use of certain medications, such as estrogen,
regulation of pituitary sensitivity and function, as
neuroleptic drugs, metoclopramide, antidepressants,
receptors of the pituitary gland surface are regulated
cimetidine, methyldopa, reserpine, verapamil,
by thyroid hormones. Therefore, thyroid hormones
standardize the number of TRH receptors on
As a result, in the study of hyperprolactinemia,
anterior pituitary mammotrophs[2].
A noteworthy association has been demonstrated
hypothyroidism should be considered[1].
amid autoimmunity and reduced levels of PRL in
It has been reported that hypothyroidism can
autoimmune diseases[10]. PRL secreted by the
cause an increase in PRL by increasing the
anterior pituitary and prolactin-like polypeptides
that are localized in the joints are effective in
Received: 29/10/2017 DOI: 10.12816/0043488
Accepted: 9/11/2017

Full Paper (vol.703 paper# 19)

c:\work\Jor\vol703_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 469-472

The Use of Butyl Bromide Medication amid Colonoscopy
Fadi Mohammed Albulayhishi 1 , Ibrahim Abdulkarim Alsayegh 2 , Asaad Abdellahi Bilal 3 , Abdullah
Sami Dahlawi 4 , Hanan Rashed Hassan Alsohabi 5 , Alzayer Mohammed Ali y 6 , Norah Mohammed H
Alharthi 7 , Hassan Saud Alshehri 4 , Abrar Ghazi A Najjar 8 , Saber Mutlaq Baseem 9 , Redwan
Muneer A Farghal 10 , Rami Mohammed Hamed Almutairi 11
1- King Faisal University , 2- King Fahad Specialist Hospital Buraydah , 3- ( General Practitioner ) King
Abdulaziz University , 4- King Abdulaziz University , 5- South Qunfuda General Hospital , 6- Imam
Abdulrahman Bin Faisal University , 7- Arabian Gulf University,8- Umm Alquraa University , 9- Aljouf
University , 10- University Of Jeddah , 11- *Ohud* Hospital Medina

: the hyoscine-n-butylbromide (Buscopan) is ought to be avoided during colonoscopy in patients
with a history of angle-closure glaucoma. Angle-closure glaucoma, nonetheless, is not very common, is
asymptomatic before onset and is treated definitively by a single laser treatment (if spotted early). Open-
angle glaucoma is not affected by hyoscine.
Purpose: the purpose of this study was to evaluate the use of hyoscine amid colonoscopists, with certain
reference to glaucoma. Materials and Methods: a short questionnaire was electronically managed to
members of the Saudi Society of Gastroenterology and the Association of Coloproctology of KSA. The use
of Hyoscine among colonoscopists and the effect of glaucoma history upon the prescribing practice.
Results: sixty-three colonoscopists responded to some or all of the questions. 41/61 (67.2%) of respondents
claimed they were aware of the guidelines. 53/62 (85.5%) sometimes or always use hyoscine, while 9/62
(14.5%) never do. 45/59 (76.3%) always enquire about glaucoma history prior to administration, even though
48/58 (82.8%) make no differentiation between open-angle or angle-closure forms. 42/59 (71.2%) would
(incorrectly) withhold hyoscine if the patient declares a history of any form of glaucoma. 46/59 (78.2%) do
not substitute glucagon as an antispasmodic. 2/60 (3.3%) had encountered ophthalmic complications post-
administration. Conclusions: current guidelines pertaining to hyoscine use and glaucoma are inappropriate.
Patients undergoing colonoscopy who have received hyoscine should, instead, be advised to seek urgent
medical advice if they develop ophthalmic symptoms.
Keywords: butyl bromide , Colonoscopy.

sickness is defined as an optic neuropathy
Colonoscopy is the process of choice for
resultant in both structural and functional defects
the analysis of patients with suspected ailment of
within the eye (optic disc damage and visual field
the colon and/or terminal ileum (1). It is similarly
loss). There are two main forms of the illness;
open-angle and angle-closure. Due to its
programmes to aid detection of colorectal
anatomical basis, angle-closure glaucoma can be
neoplasia[2]. The anticholinergic drug, hyoiscine-n-
precipitated by hyoscine administration; open-
butylbromide (Buscopan) is a smooth muscle
angle glaucoma, nonetheless, cannot. When an
relaxant frequently utilized in endoscopic
attack of angle-closure glaucoma does arise the
procedures to decrease gastrointestinal spasm.
patient regularly has had no prior clinical history,
Advocates of the utilization of hyoscine believe
and the consequent treatment (iridotomy) is
that it facilitates a complete colonoscopy and may
definitive [7]. We believe that the current
similarly help in other endoscopic procedures, for
guidelines are confusing, as by definition the
patient at risk of developing angle-closure
glaucoma will have no prior history and,
Current guidelines state that a past medical
furthermore, if a patient has been treated for angle-
and drug history ought to be attained from all
closure glaucoma, they are no longer at risk (as
patients before commencing any procedure, and
treatment is definitive). Hyoscine does not affect
that hyoscine ought to be utilized with caution or
open-angle glaucoma and, consequently, if
avoided completely in patients with a history of
clinicians do not differentiate between the two
angle-closure glaucoma [5]. Intravenous glucagon
forms of glaucoma, hyoscine might be suspended
can, as an alternative, be substituted for hyoscine
incorrectly, accordingly potentially decreasing the
if an antispasmodic is needed (2).
chances of a complete colonoscopy.
Glaucoma is a mutual eye condition that
The purpose of the present study is to
affects many people around the world [6]. The
evaluate the current utilization of hyoscine amid
Received: 19/10/2017 DOI: 10.12816/0043489
Accepted: 29/10/2017

Full Paper (vol.703 paper# 20)

c:\work\Jor\vol703_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 473-477

The Relationship of Diet and Acne
Luai Mohammed E Assaedi 1 , Saud Adel Al-Taisan 2 , Abdulrahman Ghaeb Alharbi 3 ,
Abdulaziz mohammed alsahli 4 , Rawan Ahmed Gaafar 1 , Somaya Khalid Alsharif 1 , Faris Ali
Nasser Ayidh 5 , Ali Hassan J alzahrani 6 , Toqa Eissa Aljowaid 7 , Alfaifi Adel Ali A 5 , Khadijah
Salem M Banjar 1 , Mazad Ali S Allehyani 1
1- Umm Al-Qura University, 2- Al-Ahsa (Al-Salmaniah PHC) , 3- Imam Abdulrahman Bin Faisal
University , 4- King Abdulaziz University , 5- King Khalid University , 6- King Abdulaziz University-
Rabigh Branch , 7- Ibn Sina College

Earlier, medical literature replicated that diet was not a proven cause of acne. Nonetheless,
studies in recent years have demonstrated a relation between certain dietary factors and acne. It is uncertain
whether patients are aware of recent research findings.
Acne patients were surveyed to explore beliefs concerning the relationship between diet and
acne, to determine whether these beliefs translated into behavior change and to recognize health
information sources.
Materials and Methods:
Surveys were managed to 104 acne patients at King Abdulaziz Hospital from
March2016 till February 2017, with 98 completed in full and included in this analysis.
Results: o
f the 104 questionnaires administered, 98 were completed in full and were included in the
analysis. The mean age of patients was 29 years (range, 15 to 45 years); 76 were female and 22 were male.
Six respondents had an under-weight BMI of less than 18; 62 respondents had a normal BMI between 18­
25; 26 respondents were overweight with BMI 25­30; and 4 respondents were qualified as obese with
BMI greater than 30. A majority,( 90 of 98 ) of respondents, was educated at the college level .
In this exploratory study, patients reported utilizing a diversity of information sources, a
majority from the Internet. In those surveyed, there was a persistence of long-held belief that fried/greasy
foods and chocolate may serve as acne triggers, and less belief in trigger foods supported by recent
research, including refined carbohydrates and sugar. Given the multiplicity of beliefs and utilized sources
among acne patients in our survey, there is a need to establish an up-to-date and reliable methods to
educate patients the relationship between diet and occurrence of acne.
acne, foods, diet, Internet, dermatologist.

Follow-up studies [5,6] have distinguished that
Research studies on the relationship between
transferring to a low glycemic diet led to better
diet and acne goes back periods. In the 1960s,
insulin sensitivity, lower androgen bioavailability,
numerous research groups studied this subject,
and altered skin sebum production. It is not known,
and one of the largest studies contains 65 patients.
conversely, what role individual differences,
Over a month period, subjects were managed
period of dietary changes, and other influences
either a chocolate bar or a placebo bar, and no
play in this relationship. As a result, studies such
difference in acne severity was perceived [1]. In
as Di Landro et al.'s [7] have documented the
regards to such studies, patients were advised that
opposing view that weekly intake of cakes, sweets,
diet did not impact acne. This belief was reflected
and chocolate (foods high in glycemic load) were
in textbooks, patient information brochures, and
not related with a higher risk of acne.
the medical literature [2].Nonetheless, later,
Furthermore, researchers observing the
researchers distinguished methodological flaws in
relationship between dairy intake and acne have
the original study, comprising the fact that the
distinguished some relationship. Studies [8, 9] have
placebo bar confined a comparable total sugar and
showed this relationship in three separate
fat content as the chocolate bar [3]. Additional
populaces, however, in each occurrence the
examinations have now correlated a number of
correlation outcomes were considered relatively
dietary influences and acne. The strongest studies
weak. Closer assessment of this relationship
to date specify that dietary glycemic load might
discovered that only skim milk presented a
add to acne. A randomized controlled trial of
statistically significant correlation with acne,
conceivably as a result of its increased processing
improvement of acne severity after 3months of
and/or declined estrogen content in comparison to
adherence to a low-glycemic-load diet, compared
whole milk [9].A number of other dietary factors
to the high-glycemic-load diet control group.
have been studied for their prospective role in
Received: 1/11/2017 DOI: 10.12816/0043490

Full Paper (vol.703 paper# 21)

c:\work\Jor\vol703_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 478-482

Assessment of Patients with Thoracic Trauma in
Emergency Department
Abdulrahman Fayez Kinsara 1 , Warda Dakheel Al.Masodi 2 , Abdullah Musari Alanazi 3 ,
Abdulaziz Abdulrahman Alghamdi 4 , Turki Jafar Abdulmajid 5 , Hanan Showei H Fageeh 6 ,
Ahmed Abdulelah Al Jishi 7 , Badr Wadee S Abulhamail 8 , Alsuhaymi, Zuhair Hamdan A 9 ,
Nouf Awad S Albalawi 10 , Alruwaili Amirah Radhi M 10 , Mishari Talal Al-Harbi 1
1- King Faisal Hospital Makkah , 2- Faculty of Medicine , Umm Al-Qura University , 3- Prince Abdulaziz
Bin Musaed Hospital- Arar , 4- Royal College Of Surgeons, RCSI, Dublin, Ireland , 5- Immam
Abdulrahman Al Faisal Hospital , Resident , 6- East Jeddah Hospital , 7- Anak General Hospital ,
8- King Abdulaziz University Hospital , 9- Mikhwah General Hospital , 10- Tabuk University

Thoracic trauma is a common cause of significant morbidity and mortality. The present study
presents a series of thoracic trauma and evaluation of epidemiologic features, distribution of pathologies,
diagnosis, additional systemic injuries, management and outcome.
Materials and Methods:
Between May 2016 and April 2017, all patients with thorax trauma admitted to
the emergency service of King Abdulaziz hospital were retrospectively reviewed with respect to age, gender,
etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities,
referral and outcome.
A total of 228 patients with thorax trauma were encompassed in the study. Of all the patients,
(140) , 61.4% were male and 88 (38.6%) were female. The majority of the patients presented with blunt
thoracic trauma (218 of 228 [95.6%]), whereas 10 (4.4%) presented with penetrating injuries. Etiological
factors included falls in 158 (69.3%) patients, motor vehicle accidents in 52 (22.8%), animal related
accidents in 8 (3.5%) and penetrating injuries in 10 (4.4%). Among penetrating injuries, 6 (2.6%) were
stabbing injuries and 4 (1.8%) were firearm injuries. The patients aged between 16 and 85 (mean 52.2±16.9)
years. The vast majority (69.3%) of the patients aged between 31 and 70 years. Blunt thoracic traumas were
observed most frequently in patients aged 51-70 years (36.8%), while penetrating traumas were observed
most frequently in those aged 31-50 (32,5%) years.
Even though majority of the patients with thorax trauma received treatment as outpatients;
thoracic traumas can be a life threatening condition, and should be recognized and treated immediately.
Mortality differs based on etiological factors, additional systemic pathologies, capabilities of the hospital
especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary
method to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy
in emergency services will significantly decrease the morbidity and mortality.
Thoracic trauma, Pneumothorax, Rib fractures, Hemothorax, Mortality.

Mortality as a result of trauma rank third after
Records of all patients with thorax trauma
cardiovascular diseases and cancers amid the
admitted to the emergency service of King
causes of adult death worldwide.
Abdulaziz Hospital between January 2007 and
Thoracic trauma constitutes 20-25% of all death
December 2011 were retrospectively reviewed
as a result of trauma in the first four decades [1].
in terms of age, gender, distribution by seasons

and years, pathologies in thorax, rates of emergent
As esophagus, heart, trachea, diaphragm and
tube thoracostomy, additional systemic injuries,
large vessels could be injured along with chest
hospitalization time, and mortality rates. Pediatric
cage and lungs in thoracic trauma, it might be a
patients under 16 years of age were excluded.
life-threatening condition in some cases [2]. After admission, all the patients were assessed by
Therefore, we intended retrospective clinical study
baseline physical examination, plain radiography,
of patients with thorax trauma with the purpose to
evaluate epidemiologic features, distribution of
Ultrasonography and computed tomography of
pathologies, further systemic injuries, diagnosis,
thorax were utilized in some cases when required.
management and outcome.
Tube thoracostomy was performed in all patients

with pneumothorax or hemopneumothorax by a
Received: 19/10/2017 DOI: 10.12816/0043491
Accepted: 29/10/2017

Full Paper (vol.703 paper# 22)

c:\work\Jor\vol703_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 483-486

The Incidence of Inguinal Hernia among Children

Rakan Abdulrahman Alrzoq 1 , Ammar Mustafa A Alhaji 2 , Ibrahim Yousef Ibrahim Alolayt 3 ,
Abdullah Ibrahim Almulhim 4 , Saad Ahmad Althobaiti 5 , Ismail Atiah Alzahrani 6 ,
Duaa Ahmed A Alabbas 7 , Shahad Awad Alraddadi 8 , Ibrahim Sulaiman A Alhajjam 8 ,
Methaq Abdullah Alrubyyi 2 , Sarah Abdullah Altarouti 9 , Zainab Wasel A Alhashim 10

1- Imam Muhammad bin Saud Islamic University, 2- MCH in Dammam, 3- University of Hail,
4- King Faisal University, 5- Umm Alqura University, 6- King Fahad Hospital in Albaha,
7- PHC in Al-Ahssa, 8- King Abdulaziz University, 9- B.A.U ln lebanon ,
10- Imam Abdulrahman Bin Faisal University


Objectives: The aim of this study was to document clinical features of inguinal hernia (IH) in the pediatric
populace. It delivers data to assess related risk factors of incarcerated hernia, its reappearance in addition to
the occurrence of contra lateral metachronous hernia.
Materials and Methods:
We report a retrospective analytic study comprising 230 children presenting with
IH and operated from April 2015 to June 2017 in the pediatric surgery department, King Abdulaziz Hospital.
We managed 36 girls (15.6%) and 194 boys (84.4%). The mean age was 3 years; The median age in
the studied group was 3 years (range 22 days to 12 years). Males were predominantly affected (84.4%, n =
194). The rate of IH was more important in the youngest group (age < 2 years); thus, we accounted 43.5% (n
= 100) infants. The cumulative incidence of hernia in the 2­6-year age group was 34.7% (n = 80). Thirteen
percent (n = 31) of these patients presented with an incarceration mostly on the right side (62.6%, n = 154).
We recognized that the total rate of incarcerated hernia incidence in premature group was evaluated at 27%.
This rate was high, particularly in neonates and infants. Prematurity and hypotrophy were documented in 9%
and 7% respectively. The mean follow-up period was 3.8 years. We think that incarceration can be related to
several risk factors such as feminine gender, prematurity, and the initial left side surgical repair of the hernia.
IH occurs mainly in male infants. Prematurity and male gender was identified as risk factors of
incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left
side surgical repair of the hernia.
Children, inguinal hernia, recurrence, surgery.


Inguinal hernia (IH) is the most common
pediatric surgery department, King Abdulaziz
surgical condition of childhood, affecting 1%­2%
of mature infants and up to 30% of premature
Data were collected through a standardized
infants [1].
form including age at surgery, circumstances of
One of the major complications of IH is
surgery (incarcerated or not incarcerated), hernia
incarcerated hernia. The risk of incarceration in
side, the occurrence of metachronous hernia, and
children with IH ranges from 3% to 16%, with the
postoperative complications. Patients presenting
highest incidence estimated to be 30% in
with crural hernia or undescended testis with a
premature children [2].
surgical repair of a persistent peritoneal-vaginal
In the present study, we reviewed 230 children
duct were excluded from the study. Children were
to evaluate clinical features of IH in the pediatric
managed by herniotomy with direct inguinal
population and to evaluate associated risk factors
method consistent with Forgue technique.
of incarcerated hernia, its recurrence as well as the
The so-called Barker artifice was performed in
occurrence of contralateral metachronous hernia.
all female infants to repair the round ligament.

Statistical analysis was performed using Excel
Microsoft office 2013 (codenamed office 15), and
We reported a retrospective analytic study
variables were compared with Chi-squared test.
comprising 230 children presenting with IH and
The study was done according to the ethical
operated from April 2015 to June 2017 in the
board of King Abdulaziz university.

Received: 2/11/2017 DOI: 10.12816/0043492
Accepted: 12/11/2017

Full Paper (vol.703 paper# 23)

c:\work\Jor\vol703_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 487-490

Irritable Bowel Syndrome in the Saudi Population
Yaser Yousef Khogheer 1 , Alruwaili Amirah Radhi M 2 , Muataz Abdulmoghni Aljunaid 3 ,
Feras Hammad Alhussainy 4 , Salem Waleed Bin Jabal 4 , Saleh Hussain S Alramadan 5 ,
Yousef Saleh Alwosidi 6 , Ahmed Nasser A Alharbi 7 , Zainab Ali Alsairafi 8 ,
Reem Ibrahim H Al Radhidy 9 , Ali Hussain A AlDawod 5 , Yasir Hameed H Albeladi 10
1- East Jeddah Hospital, 2- Tabuk University, 3-King Abdulaziz University,
4- Arabian Gulf University, 5- Imam Abdulrahman Bin Faisal University,
6- King Saud Bin Abdulaziz For Health Sciences, 7- Qassim University ,
8- Anak General Hospital, 9- Qassim University -UCM , 10- Armed Forces Hospitals , Jazan

Irritable Bowel Syndrome (IBS) is a very common gastrointestinal dysfunction.
Notwithstanding strong evidence of high prevalence of depression and anxiety in IBS there is very limited
research on this topic in KSA.
Materials and Methods: Cases of irritable bowel syndrome and controls with non-ulcerative dyspepsia
were employed between March 2016 to May 2017 from the gastroenterology department in King
Abdulaziz hospital, KSA. Presence of anxiety disorder and depression were evaluated by utilizing the
Hamilton Anxiety rating scale and Hamilton Depression rating scale respectively. Occurrence rates of
anxiety and depression were established and Odds Ratio (OR) was calculated to determine the association
of depression and anxiety disorders with IBS.
Results: In IBS cases, the prevalence of depression and anxiety disorder was 37.2% and 31.5%
respectively. In patients with irritable bowel syndrome the OR for depression was 6.1 (95% CI 1.7-23.6,
P=0.008) and the OR for anxiety disorder was 7.3 (95% CI 1.5-36.2, P=0.011).
Conclusion: The occurrence of depression and anxiety disorder in IBS is very high. As a result, screening
of IBS patients for anxiety and depression would facilitate better interventions and consequently better
outcomes and medical treatment.
Keywords: Anxiety, depression, irritable bowel syndrome.


Irritable bowel syndrome (IBS) is a functional
a significant role and can even act as markers of
gastrointestinal (GI) disorder characterized by
IBS onset[6].
abdominal pain and altered bowel habits in the
Recent studies have shown that subjects
absence of a specific and unique organic
with IBS have higher levels of depression, anxiety
pathology. Osler coined the term mucous colitis in
and neuroticism as compared to those without
1892 when he wrote of a disorder of mucorrhea
irritable bowel syndrome [7 ,8]. Several studies
and abdominal colic with a high incidence in
have shown that as many as 30-40% of patient
patients with coincident psychopathology. Since
with IBS have co-morbid depression or anxiety
then, the syndrome has been referred to by sundry
terms, including spastic colon, irritable colon, and
It has similarly been described that patients
nervous colon [1].Earlier, irritable bowel syndrome
who come to medical attention tend to have a
has been considered a diagnosis of exclusion;
greater number of symptoms and are more
nevertheless, it is no longer considered a diagnosis
anxious and depressed[11].
of exclusion, but it does have a broad differential
On the other hand, most of the evidence on
diagnosis [2]. No specific motility or structural
IBS and co-morbid depression or anxiety disorder
correlates have been consistently demonstrated;
comes from western studies. There is very little
however, experts suggest the use of available
research looking into the pervasiveness of these
guidelines can minimize testing and aid in the
psychiatric disorders in patients with IBS in other
diagnosis. IBS places a heavy burden on health
countries. Given the fact that there are significant
services and accounts for 20-50% of referrals to
socio-cultural differences, it is difficult to
gastroenterology clinics [3].However, a number of
generalize research findings from developed
biological triggers have been suggested for
countries. It consequently, warrants a requirement
beginning of IBS[4, 5], it has correspondingly been
to undertake basic research in other countries.
recommended that psychological factors, mainly
Accordingly, the purpose of this study was to
those linked with the process of somatization play
strengthen the limited evidence based on

identifying the pervasiveness of common mental
Received: 1/11/2017 DOI: 10.12816/0043493
Accepted: 12/11/2017

Full Paper (vol.703 paper# 24)

c:\work\Jor\vol703_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 491-498

Assessment of Knowledge, Attitude and Practice of Hand Hygiene among
Health Care Workers in Arar City, Saudi Arabia
Rawan Deham I Aledeilah1, Nagah Mohamed Abo el-Fetoh2, AmnahFarhan Albaker3,
Alaa Ahmed Aljabbab4, Sarah Jamal Alkhannani3, Saja Jamal alkhannani5,
Tasneem Saeed Almahroos3, Abdalla Mohamed Bakr Ali6
1 Primary Health Care Center, Arar, KSA.2Family and Community Medicine Department,
Faculty of Medicine, Sohag University, Egypt &Northern Border University, Arar, KSA,
3 Primary Health Care Center, Riyadh, 4Arar Central Hospital, Arar, 5Faculty of Medicine,
Northern Border University, Arar, KSA,6Faculty of Medicine, Sohag University, EGYPT

Hand hygiene before and after each contact with any patient, is simple, easily implemented
and an effective practice to prevent hospital acquired infection.This study aimed to assess the knowledge,
attitude and practice of hand washing among health care workers (HCW) in health care units in Arar city,
Northern Saudi Arabia, based on WHOs ,,Five Moments of Hand Hygiene Questionnaire. Methodology:
A descriptive cross sectional study was carried out at health care unites in Arar city during the period from
July to September 2017. The World Health Organization (WHO) "Hand Hygiene Knowledge
Questionnaire"- revised 2009 edition was used. Results: In total, 116 respondents including 32 residents, 92
nurses and 37 nursing assistants enrolled in this study,68% of them were females and 32% were males, 41%
were resident, 32.8% nurses, 12.9% Nursing assistant and 12.9% Technician. The mean score of HH
knowledge in residents technicians, nurses and nurse assistants was 18 (±1.8), 17.7(±1.7), 18.3(±1.2) and
18.1(±1.4) respectively. While the mean score of attitude was the highest in nurses 6.9(±1.17) then the
technicians 6.8(±1.6), and the lowest score was found in the nursing assistants 6.2(±0.56). The mean score
of practice was found to be 4(±1.6) in technicians, 3.9(±1.0) in nurses, 3.8(±0.9) in residents and 3.5(±0.6)
in nurse assistants. The majority of the participants (90.5%) had a high level of knowledge of HH. The
attitude level was found moderate in 81.9% and high in only 17.2%. Level of practice of HH was high in
23.3%, moderate in 75.9% and almost none of our participants was found with a low level of practice.
Conclusion: This study highlighted the importance of applying the multimodal training program addressing
providers' knowledge regarding hand hygiene, as well as strategies for emotional and behavioral methods
such as patient engagement in hand-hygiene interventions.
Keywords: Hand hygiene; Infection, Health care workers; Knowledge; Attitude; Practice; Arar; Northern
Saudi Arabia


Healthcare workers have been identified as the
patient is an important measure to prevent
most common vehicle for transmission of most
Hickman catheter-related infection (HCRI) in
nosocomial infections (health care associated
cancer patients [4]. Health care related infection is
infections) from patient to patient and within the
estimated to affect 10% of patients in developed
healthcare environment [1]. These infections can be
countries, and 25% in developing countries [5]. The
life-threatening and difficult to treat. Health care-
reasons for low levels of practice of hand hygiene
associated infections can be received from infected
have not been defined in developing countries
or draining wounds, frequently colonized areas of
probably due to limited observation and studies on
the intact patients skin, patients gowns, bed
hand hygiene [6]. Wisniewski et al. [7], stated that
linen, bedside furniture and other objects in the
lack of awareness and knowledge among health
immediate environment of the patient.
care workers as regard the importance, techniques,
It has long been known that Practicing hand
methods and quality of hand hygiene considered
hygiene (HH), either washing the hands with water
the main factors that contribute to non-compliance
and soap or using alcohol-based hand rub is the
to Hand Washing among health care workers.
most effective way of preventing the spread of
Hand hygiene also is an effective and cost-
infectious diseases [2]. Hand hygiene is simple,
efficient way to reduce the number of
easily implemented and an effective practice that
microorganisms, thereby reducing the rate of
can reduce the risk of infection [3]. Proper hand
transfer of microorganisms to hospitalized patients
hygiene before and after each contact with any
and this will reduce the number of HCRI [8].
Received: 23/10/2017 DOI: 10.12816/0043494
Accepted: 3/11/2017

Full Paper (vol.703 paper# 25)

c:\work\Jor\vol703_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 499-502

Assessment of Knowledge and Attitude and Practice towards Breast
Cancer Screening among Female in Abha City,2017
Reem Ali Almanie1, Roaa Fahad Alshabanah1, Norah Ibraheem Almanie1,
Tahani Saeed Almohayya1, Ebtesam Mohammed Alahmari1, Eman Mohammed Almaher2
1-King Khalid University, 2-Taibah University

Assessing the knowledge, attitude and practices of Saudi women toward breast cancer
preventive practices improve the possibility of reducing the percentage of deaths from breast cancer as well
as its prevalence. Objectives: Evaluating the knowledge and attitude and practice (KAP) towards breast
cancer screening among female in Abha city in Kingdom of Saudi Arabia (KSA).
Methods: A cross-sectional study was done and based on a questionnaire sheet conducted in Abha City
during the period of September to November 2017 among421 educated Saudi women aged from 20-60
years old. Results: The female's knowledge about the symptoms was restricted to pain in the breast and
presence of lump either in the breast or under the armpit, but most of them underestimated the other signs
of breast cancer including changing the position and pulling of the nipple, bleeding or discharge from the
nipple, nipple rash and redness of the breast. Also, the most significant identified risk factors for breast
cancer were family history (59.1%) followed by using hormonal replacement therapy (30.2%). Most of the
subjects has negative attitude toward using mammography for screening while a positive attitude was
shown toward seeking for medication. The KAP score was adequate among only 32.5% of the subjects
toward breast cancer.
Conclusion: The level of knowledge about breast cancer was insufficient among the included subjects and
resulted in inappropriate attitude and practice pattern.The majority have never checked for breast cancer or
either admitted to clinical examination of breast using mammography screening technique .
Keywords: Knowledge, Attitude, Practice, Breast Cancer, Saudi Female, Abha, KSA.


Breast cancer is a major health condition
decrease the severity of the disease through
that varies in rates with the highest incidence in
proper management during early period (8).
developed countries while in developing
Assessing the knowledge, attitude and
countries the prevalence rate is still low (1).
practices of Saudi women toward breast cancer
According to the International Agency
preventive practices will improve the probability
for Research on Cancer in 2008, breast cancer
of reducing the level of deaths from breast cancer
resulted in about 7.6 million deaths and more
as well as its prevalence. There are few studies
than 12 million new cases (2). The prevalence of
conducted in KSA among women thus, other
breast cancer in KSA was estimated to be about 8
studies are needed for assessing the preventive
thousand in 2006 (3).
practices and the usage of mammography among
This number increased by the year 2010
Saudi females (9, 10).The present study aimed at
to reach about 27% of the diagnosed cancers
assessing the knowledge and attitude and practice
were breast cancers among females aged more
towards breast cancer screening among female in
than 40 years (4).
Abha city.
There was an inverse association

between using early mammography screening
and the reduced death rates from breast cancer (5)
Study design
thus, annual mammograms are recommended for
It is a cross-sectional study based on a
women who are older than 40 years especially
questionnaire sheet conducted in Abha City
those with a family history of breast cancer(6)
during the period of September to November
according to the National Comprehensive Cancer
Network (7).
Study population and sample size
The severity of the disease would be
A convenience sample of women was randomly
higher among older women with a family history
chosen from different parts of Abha City. The
of breast cancer and the prognosis will be poor
respondents were interviewed in shopping malls
thus the early identification of breast cancer will
during the study period. The included subjects
Received: 3/11/2017 DOI: 10.12816/0043495
Accepted: 13/11/2017

Full Paper (vol.703 paper# 26)

c:\work\Jor\vol703_27 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 503-506

Assessment of Knowledge toward Initial Management of Acute
Poisoning among Medical Students in Riyadh City KSA, 2017
Fatmah Ali Abdullah Hakami1, Asaad Abdellahi Bilal 2, Atheer Ibrahim Alqubaysi1
Mohammed Ghazi Alharbi3
1-King Khalid University, 2- King Abdulaziz University, 3-Hera General Hospital

Background: Acute poisoning is a common situation that occurs due to administrating harmful substances that
impact the health with significant costs and increasing the rates of admission to emergency departments.
Objectives: Assessing the knowledge of Saudi medical students toward the initial management of acute
poisoning in Riyadh Region, Kingdom of Saudi Arabia (KSA). Methods: A cross-sectional study was done
based on a questionnaire sheet conducted at Riyadh region in KSA from August to October 2017 among
medical students. Results: Most of the subjects were at the seventh semester (69.7%), followed by 23.7% in
the fifth academic semester and 13.7% at the sixth academic year. About 69.7% and 65.3% had previous
exposure to first aid training and training in emergency setting. Most of the subjects had good knowledge
about the definition of poisoning, early stages of acute poisoning, importance of maintaining airway,
respiration and circulation as well as initial management using gastric lavage, char coal and antidotes. The
level of knowledge was good among 77.3% of students but was insufficient among 22.7% of subjects. There
were a significant association between higher educational semesters, training about first aid as well as training
in emergency departments. Conclusion: The level of knowledge about initial management of acute poisoning
was adequate among most of the students and was associated with training programs and experience in
emergency departments. This study presented the importance of educational and training programs from the
first year of the college to increase the knowledge and practice to save more lives.
Keywords: Knowledge, Acute Poisoning, Medical Students, Riyadh City, KSA, 2017.


the knowledge of Saudi medical students toward the
Acute poisoning is a common situation that
initial management of acute poisoning.
occurs due to administration of harmful substances
that impact the health with significant costs(1). It is
Study design: A cross-sectional study was done
the reason for high rates of admission to emergency
based on a questionnaire sheet conducted at Riyadh
departments all over the world(2) which resulted in
region in KSA from August to October 2017.
in higher morbidity and mortality rates among over
Study population and sample size: a random sample
one million persons annually (3). The majority of
of medical students was chosen using multi-
incidence rates were found among populations from
stratified random sampling technique in which 300
developing countries due to the accidental use of
students were included from 3 different medical
toxic materials (4, 5). However, there is no distinct
universities. The inclusion criteria were Saudi
number about the real prevalence of poisoning
medical students from different semesters who were
because of the lack of true and exact reports on the
exposed to clinical settings during these semesters.
occurrence of the poisoning cases (5).There are major
types of acute poisoning including drug overdoses,
Study tools
chemicals and pesticides (6).
A self-administrated questionnaire was used after
Thus, proper management and admission of
conducting a systemic search using Scopus,
first aid are lifesaving during these conditions before
Pubmed, Google Scholar and other available search
the medical care of health professionals (7).The
engines for preparing a valid and reliable
medical students who are being taught at the
questionnaire. The questionnaire was collected, then
hospitals should learn how to handle emergencies in
reviewed by 3 supervisors to be validated. The
the clinical departments until the health
questionnaire consists of 2 parts that deals with the
professionals are available thus, the adequate
demographics of included students, knowledge level
knowledge have to be early acquired by the medical
toward acute poisoning.
students about initial management of emergent
Ethical approval
cases and the first aid(8, 9). Many studies showed an
The study protocol and the questionnaire were
inadequate level of knowledge and practice among
approved by the supervisors before conducting the
medical students thus, even junior doctors may be
study. Also, all the included students provided an
incapable of performing the first aid skills for those
informed approval to participate in the study. The
attending emergency department(10, 11). In KSA, there
study was done after approval of ethical board of
is a lack of studies assessing the KAP of medical
King Abdulaziz university.
students toward handling the emergency acute
Statistical analysis: the results were analyzed using
poisoning hence the present study aimed at assessing
the Statistical Package for Social Sciences (SPSS)

Received: 18/10/2017 DOI: 10.12816/0043496
Accepted: 28/10/2017

Full Paper (vol.703 paper# 27)

c:\work\Jor\vol703_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 507-510

Assessment of Knowledge, Attitude and Practice (KAP) of Saudi Adult toward
Blood Donation in Riyadh City, 2017
Sultan Hamad Almutairi1, Abdulrahman Ahmed Almalaq2, Yousef Musallam Albalawi3,
Rayan Mohammed Aloufi3, Moodhi Rabih Al-Mutairi4, Amjad Fawzi Albiek5
1-King Saud Bin Abdulaziz University for Health Sciences,2-University of Hail,
3-Tabuk University,4-Qassim University,5-Taibah University

Blood donation can save the lives of people who are in serious conditions thus it is a global
concern of all societies.
Objectives: Evaluating the knowledge, attitude and practice (KAP) of Saudi adult subjects toward blood
donation in Riyadh City.
Methods: A cross sectional community survey design was conducted among 500 adult Saudi subjects who
were interviewed in shopping malls of Riyadh City during the period from May to July 2017. The
questionnaire included interview regarding the demographics of respondents, knowledge, attitude and practice
regarding blood donation.
Results: All the participants had significant knowledge about their blood group and the importance of blood
donation. Also, the majority of respondents had adequate knowledge about the most common site of blood
donation, the specificity of blood groups and the dangerous of donation of subjects with infection. Also, a good
knowledge was found among most of respondents regarding the time, the complications and the precautions of
blood donation. The attitude and practice pattern of participants were good among most of the participants
.The KAP was adequate among 71% of respondents regarding blood donation and there was a significant
association between the respondents good KAP with young age, male gender and higher educational degree.
Conclusion: The KAP of most of Saudi subjects was good and showed a high prevalence of blood donation
among them with a favorable attitude to donate blood.
Knowledge, Attitude, Practice, Blood Donation, Riyadh City, 2017.


thus the transfusion is limited to relatives with
The blood is the body fluid which carries
special precautions (6).
oxygen and essential substances to the cells as
In developing countries, there was an
well as getting rid of the metabolic waste products
adequate knowledge among 60% of population
from cells. The blood transfusion process begins
about blood donation but the rate of blood
with obtaining a volume of blood from a healthy
donation was still low than middle and high
person to a patient's circulation whose blood is
income countries (7, 8). The blood donation
deficient through injection. The need for blood
prevalence in Kingdom of Saudi Arabia (KSA)
transfusion may be due to sudden loss of blood in
ranged from 45-53.3% (9).
an accident or due to diseases and surgery(1, 2).
More blood means more life as supposed
The study aimed at evaluating the
by the world blood donor day. And the WHO
knowledge, attitude and practice (KAP) of Saudi
stated that about 93 million subjects from 173
adult subjects toward blood donation in Riyadh
countries are donating annually (3). Blood donation
can save the lives of people who are in serious

conditions thus it is a global concern of all
societies (4).
Study design
During the last few decades, the number
A cross sectional community survey
of active blood donors was decreased and couldn't
design was used.
meet the increased demands for blood transfusion.
Study subjects
Also, most of donors are involuntary who came

Saudi adults aged between 20-45 years old
only for their relatives or friends and paid donors
from both genders who were interviewed in
while those who usually donate are few (5).
shopping malls of Riyadh City.
Also, the issue of safety of blood
Study population and sample size
transfusion and avoiding transmissible infections
The sample size was calculated according
is a concern especially in developing countries
to a pervious study (10) with a 95% confidence

interval land a margin of error of 5% and the
Received: 19/10/2017 DOI: 10.12816/0043497
Accepted: 29/10/2017

Full Paper (vol.703 paper# 28)

c:\work\Jor\vol703_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 511-513

When a Simple Serum Ferritin Level Measurement Misleads the Diagnosis
of a Neonate in the NICU: A Case Report and Review of Literature
Taha B. Aljishi1 and Mohammad A. Al Ghamdi2
1 Department of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Dammam,
2Department of Pediatrics, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
*Corresponding author: Taha B. Aljishi, E-Mail: taha900@hotmail.com, Mobile: 00966555078668

This case report describes a newborn girl born with non-immune hydrops fetalis with bicytopenia and elevated
iron indexes. A genetic study which was done revealed a positive result for the H63D homozygous mutation.
Iron overload is rare in patients homozygous for the H63D mutation because of its variable penetrance,
especially in the neonatal period. The possibility of neonatal hemochromatosis (NH) on top of positive results
for hereditary hemochromatosis (HH) was anticipated. Despite all the recommended healthcare measurements
being provided for both diagnoses, the child developed liver failure of unspecified etiology and was deceased
Keywords: HFE gene, p.H63D, Ferritin, iron overload, neonate, non-immune hydrops fetalis, anemia,


Hereditary hemochromatosis (HH) is an
autosomal recessive disease that leads to excessive
This full-term newborn girl is a product of
absorption of iron and its deposition in different
normal vaginal delivery, born to a 34-year-old
organs tissues, eventually causing organ damage in
mother, originally from Northern Saudi Arabia,
advanced ages (1-3,6). High Ferritin (HFE)-related
with no antenatal care. The mother gave birth to 3
HH is the most common genetic defect in the
normal siblings.
The parents are non-
northern European population. It has been
consanguineous, and both are healthy. Her Apgar
estimated that it affects 1 case in 200-500
scores were 1 and 5 at 1 and 5 minutes
individuals in the US (2,4,5). C282Y and H63D are
respectively. Her birth weight was 2.9 kg and
the two mutations in HFE gene most commonly
growth parameters were within the normal range.
identified (1,6). Being the most penetrant (4), C282Y
She was born hydropic, pale, with generalized
has been well established in the development of
petechiae and respiratory distress. She had been
the disease and the overall clinical significance.
H63D penetrance, on the other hand, was found to
be variable and less likely to be associated with an
Her initial lab results were as follows;
overt significance of HH (1,6).
hemoglobin level 4.1 g/dl, reticulocytes 10-14%,
On the other hand, hemochromatosis in
platelet 8000/ml, white blood cells 20,100/ml and
neonates (NH) is a rarely found disorder. Iron
no coagulation abnormalities were evident. Liver
accumulation in liver and other organs is an
function tests were normal except for the low level
anticipated outcome in most of the cases.
of albumin 1.4 g/dl. Direct bilirubin was 0.6 mg/dl,
Originally, it was thought to be HH, however,
but rapidly increased to 22.6 mg/dl by the tenth
recent hypotheses came to conclude that <59% of
day with normal liver enzymes. Hemoglobin
cases had been described were attributed to a
electrophoresis showed hemoglobin A 89.5%,
gestational alloimmune disorder (GALD). Non-
hemoglobin A2 2.6%, and hemoglobin F 7.9%
GALD etiologies can rarely cause NH.
interpreted as a normal hemoglobin fractionation
In this case report, we describe a newborn
pattern after transfusions. Coombs' test showed 2
girl who was born hydropic with bicytopenia. All
positive results, however, insignificant after
investigations were insignificant, except for
transfusions. Labs also revealed negative DCT and
hyperferritinemia and the genetic panel which
Ham test. Evaluation for neonatal lupus revealed
were positive for the H63D homozygous mutation.
negative results. Antiphospholipid antibody panel,
The importance of basic lab investigations and
Alpha 1-antitrypsin, immunoglobulins were all
consideration of all the possible diagnoses,
normal. All viral serology was negative. Follow-
including rare ones, will be emphasized in this
up investigations of Brucella IgM and IgG,
case report.
syphilis and malaria were negative. Metabolic
The study was done after approval of
screen and chromosomal analysis were normal. As
ethical board of Imam Abdulrahman Bin Faisal
for imaging investigations, the chest x-ray and
echocardiogram showed bilateral pleural effusion
Received: 27/10/2017 DOI: 10.12816/0043498
Accepted: 7/11/2017

Full Paper (vol.703 paper# 29)

c:\work\Jor\vol703_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (3), Page 514-519

Wound Management in Primary Care: A Review
Mohammed Yossef Al-Habib 1, Sarah Naif Alsayil 2, Omar Salem Al-Qasim 3,
Sarah Fahad Alrayyes 4, Jumanah Ahmed Al-Saedi 5, Abdulrahman Mubarak Alshammari 6, A
mnah Ahmed Al-Jaffar 7, Ibrahim Mohammed Al-Jassim 8, Mohammed Awwadh Almutairi 9,
Hend Faleh Alreshidi 10, Hind Naif Alshammari 11.
1King abdulaziz university, Jeddah, 2Guryat General Hospital, Guryat, 3King Faisal University, Al-Ahsa,
4Prince Mutaib bin Abdulaziz Hospital, sakaka, 5Umm al-Qura university, Mecca, 6Hail University, Ha'il,
7Mohammed almana college, Dammam, 8Dammam university, Dammam, 9Majmaah university, AL Majma'ah,
10Hail university, Ha'il, 11 Hail university, Ha'il, Saudi Arabia

In this review, we discuss assessments methods of patient's step by step in primary care. We outline the
cleansing methods of wounds and guidelines for wound management depending on the type of wound. We
review the most updated studies in the management approaches wound in primary care, but we also included
some studies which have been published earlier since 1995 December, up to November, 2017. The Midline
(PubMed) and Embase databases were searched for relevant articles related to our concern subject. Holistic
assessment involves identifying, gathering and interpreting information about the patient and wound to ensure
accurate diagnosis, appropriate treatment, ongoing monitoring and prevention of complications. For successful
management of patients wounds, physicians need proper understanding of the recovery procedure. The use of a
standardized, systematic method of evaluation assists the practitioner in the accurate investigation of the wound,
with the general goal of assuring optimal wound healing in addition to patient outcomes. Acute wound
management varies based upon the wound location and characteristics. No single method can be applied to all
wounds; however, a systematic technique to acute wound care integrated with current best practices gives the
structure for exceptional wound management
Keywords: Wound, physical trauma, Primary Care, wound management.


The method of wound care has enhanced
of this and producers started producing occlusive
tremendously and evolved over the years. The Greek
wound dressings, which were designed to maintain
physician Galen (120-201A. D) had actually kept in
and secure a moist environment in the injury. Newer
mind empirically that wounds recover efficiently in a
occlusive dressings accelerate re-epithelialization,
moist environment. However, for almost 2000 years,
promote collagen synthesis, produce a hypoxic
therapeutic efforts had actually concentrated on
environment at the injury bed to promote
drying the wound site with absorptive gauzes
angiogenesis & decline pH at injury surface, creating
functioning as main stay for wound management.
an environment inhospitable to bacterial growth,
They even promoted debridement, if utilized as a
which reduces the rate of wound infection [4].They
wet to dry dressing. The value of these gauze
have an edge over gauze dressings in regards to
dressings is currently questionable due to the pain
patient comfort, convenience and compliance as well
and damages that they trigger to the neo-epithelium
as better cosmetic outcomes as a result of decreased
throughout removal. In 1962, Winter [1] discovered
scarring [5].The idea of establishing modern dressings
that occluded wounds needed much less time for
is to manipulate the wound environment in
epithelialization compared to wounds left open to
deliberate methods. The huge variety of products
air, which was sustained by Cho and Lo [2].A closed
offered in the market today makes choice of one of
dressing exposes the wound constantly to
the most suitable dressing for any wound an
proteinases, chemotactic, enhance & development
extremely difficult task.
factors in the surrounding liquid, which may be
Nonetheless, the standard principles of injury
otherwise lost in case the injury is left
management should not be disregarded and these
exposed[3].Even the electrical gradient required for
therapeutic modalities must not be used as a panacea
stimulation of fibroblasts and epithelial cell
to injuries, which could lead to disasters.
migration is maintained and additional trauma to the
In this review, we discuss assessments methods of
injury is prevented by this physical obstacle. In late
patient's step by step in primary care. We outline the
20th century, more medical data was released in help
cleansing methods of wounds and guidelines for
Received: 27/10/2017 DOI: 10.12816/0043499
Accepted: 7/11/2017

Full Paper (vol.703 paper# 30)