c:\work\Jor\vol705_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 713-717

Glucose-6-phosphate dehydrogenase deficiency (G6PD)
(Favism) in Dammam, Eastern Province of Saudi Arabia
Almutairi, Meshael Kareem O1, Alsayyid, Amnah Abdulrahman H1,
Nagah Mohamed Abo el-Fetoh2, Abdulelah Aziz Eissa Alenzi3
1Imam Abdulrahman bin Faisal University, Dammam, 2Family and Community Medicine Department,
Faculty of Medicine, Northern Border University, 3Northern Border University, Arar, KSA

ABSTRACT
Background
: Glucose-6-phosphate dehydrogenase deficiency is an X linked recessive disorder expressed
mostly in males. It is the most common enzyme deficiency worldwide, causes a spectrum of disease
including neonatal hyperbilirubinemia, acute hemolysis, and chronic hemolysis.
The aim of the study was to determine prevalence, risk factors of G6FD deficiency and its symptoms
among general population of Dammam, Eastern Province of Saudi Arabia.
Methods: A cross-sectional study was conducted during the period from 1 March 2016 to 30 July 2017.
Data was collected from 182 individuals. Systematic random sampling technique was followed. Data was
collected by using predesigned online questionnaire. Results: The overall prevalence of favism was 17%, of
them, 67.7% were females and 32.3% were males. 15.2% of cases and 26.9% of the total sample had family
history of the disease. Among the studied cases, 48.4% complained of pallor, 45.2% headache, 45.2%
drowsiness, 12.9% nausea, 32.3% back pain, 64.5% tiredness, 25.8% abdominal pain, 38.7% discoloration of
urine, 29% foot pain, 16.1% low grade fever and 19.4% complained of jaundice. Regarding risk factors of
favism; 32.3% reported excess beans intake, 12.9% antibiotic intake and only 9.7% reported bacterial or
viral infection. Conclusions: Glucose-6-Phosphate Dehydrogenase deficiency is a common disorder as it
affects 17% of the study population of Dammam, Eastern Province of Saudi Arabia. It was more common in
females than males. Health education sessions and further epidemiological studies are required because early
detection and prevention is the key strategy for successful management and control of this genetic disease.
Keywords: Glucose-6-phosphate dehydrogenase (G6PD), Prevalence, Risk factors, Favism, Dammam,
Eastern Province of Saudi Arabia.

INTRODUCTION


Glucose-6-phosphate dehydrogenase (G6PD) is
the most common inherited enzymopathy [6].
a highly conserved housekeeping enzyme and rate-
Clinically, this deficiency affects
limiting enzyme of the pentose phosphate pathway
as many as 400 million individuals worldwide [2]
in all cells [1]. G6PD is a ubiquitous enzyme that
and predisposes affected individuals to neonatal
must be quite ancient in evolution because it has
jaundice, drug- or infection-mediated hemolytic
been found in all organisms, from prokaryotes to
crisis, favism, and, less commonly, to chronic
yeasts, to protozoa, to plants, and animals [2, 3].
nonspherocytic hemolytic anemia [7].
Glucose-6-phosphate dehydrogenase deficiency is
The aim of the study is to determine prevalence,
the most common enzyme deficiency worldwide.
risk factors of G6PD deficiency and its symptoms
It causes a spectrum of diseases including neonatal
among general population of Dammam, Eastern
hyperbilirubinemia, acute hemolysis, and chronic
Province of Saudi Arabia
hemolysis. Persons with this condition also may be

asymptomatic [4].
PATIENTS AND METHODS
G6PD deficiency results from mutations in the

G6PD gene and is well-known common cause of
Study design and setting: A cross-sectional study
hemolytic anemia in human [5]. Because acute
was carried out on population of Dammam, Eastern
hemolysis is caused by exposure to an oxidative
Province of Saudi Arabia, KSA.
stressor in the form of an infection, oxidative drug,
Study period and target population: This study
or fava beans, treatment is geared toward
was conducted during the period from 1 March
avoidance of these and other stressors. Acute
2016 to 30 July 2017.
hemolysis is self-limited, but in rare instances it
Sampling: The sample size was calculated using
can be severe enough to warrant a blood
the sample size equation: n=z2p (1-p)/e2. Data was
transfusion
[4].
Glucose
6-phosphate
collected from 182 individuals aged between <20 to
dehydrogenase (G6PD) deficiency was discovered
60 years old. Systematic random sampling
more than half a century ago and is still
technique was followed.
713
Received: 6/11/2017 DOI: 10.12816/0043971
Accepted: 16/11/2017

Full Paper (vol.705 paper# 1)


c:\work\Jor\vol705_2 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 718-722
How Intern Doctors Deal with Hepatitis B in Riyadh and
Eastern Saudi Arabia
Saad K Boqursain1, Hawraa R Alsuroj 1, Musaab I alhawas 2, Abeer A Alkhalaf 3,
Hussain S Almazyadi 4, Muhannad M Aldubaykhi 5, Amjaad S AlJelban 6, Shahad T Aldawsari 7,
Mouhab R Jamalaldeen7, Mohammed H Alshehri 7, Maitham S Alzaer 4, Matra M Fagihi8,
Mohammed S Alharthi8, Fahad F. Almutairi9, Sajjad M almusawi 4, Mohammed H Almahdi10
1King Faisal University, 2 Maternity and Children Hospital, 3Princess Noura University, 4Wroclaw Medical
University, 5Qassim University, 6King Khalid University, 7King Saud University, 8Prince Mansour Military
Hospital, 9Almaarefa College, 10King Fahad Hospital in Hofuf.

ABSTRACT
Background:
Hepatitis B is one of popular health problem and is considered as major global infectious hazard.
It represents an occupational risk for all people who are working in healthcare, including doctors, nurses,
laboratory staff, and training interns as well as the student who is trained in hospitals. This can be correlated
with their contact with body fluids during clinical rotations and activities. However, protection from getting any
infection logically is mandatory for healthcare worker. Aim: Our problem in this study was to assess how our
new doctors in Saudi Arabia, specifically those in Riyadh Region and Eastern Region are safe and are protected
from hepatitis B infection by evaluating their knowledge, attitude and practice towards Hepatitis B. Method:
That was a cross-sectional study which was conducted to intern doctors in Riyadh and Eastern Regions.
Random sampling technique was used to select 350 intern doctors. Study tool was a self-administrated
questionnaire that is made online by using Google drive forms and sent as an internet link to all interns via
WhatsApp mobile application. Data analysis was done using computer application SPSS 24. Comparison
between results and many variables was done using Chi-Square test and statistical significance is considered
when P-Value < 0.05.
Result: In this study, 131 intern doctors participated out of 350 who received the questionnaires (response rate
94.6%). Regarding the level of knowledge, attitude, and practice, around 86% of participants have good
knowledge, 63% of them have a positive attitude and 85% have a good practice. Chi-Square test was applied to
compare our results of KAP with gender and region. No difference between males and females was found in the
level of knowledge and attitude (P-value > 0.05). Males were better than females in practice (P < 0.05). Intern
doctors in Riyadh region were better than those in Eastern region in knowledge and attitude (P-value < 0.05), no
difference was found between them in practice (P-value > 0.05). Conclusion: It was obvious that our new
doctors in Eastern and Riyadh regions have good knowledge, attitude and practice for Hepatitis B. People in
Eastern region have less knowledge and attitude compared to those in Riyadh with a significant difference
between them. Also, males interns have a better practice than females interns in general.
Keywords: Hepatitis B, Saudi Arabia, Intern Doctors, Riyadh region, Eastern region.

INTRODUCTION

Viral hepatitis is an inflammation of the liver
infected and around 240 million developed chronic
that leads to chronic liver disease, liver cirrhosis,
hepatitis B infection, with a mortality rate of one
and hepatocellular carcinoma and finally, may
million every year [3]. However, Hepatitis B is
cause fulminant hepatitis. Hepatitis B is one of the
highly prevalent among healthcare workers and it is
most common viral hepatitis in addition to hepatitis
two to ten times more than others [4].
C [1]. Hepatitis B is one of the popular health
In Saudi Arabia, the story of hepatitis B, in
problems and is considered as a major global
general, is better due to Hepatitis B vaccination that
infectious hazard. It also represents the
was started in 1989 and immunization program that
occupational risk for all people who are working in
was started at 1990 included health care workers as
healthcare, including doctors, nurses, laboratory
well as other people at risk of getting hepatitis such
staff, and training interns as well as the student who
as children in school [5]. So, this is considered a
is trained in hospitals, due to their contact with
good indicator of the efforts done by the Saudi
body fluids during clinical rotations and activities
government to protect healthcare workers from
[2]. Hepatitis B is highly prevalent all over the
getting infected with their clinical exposure.
world, in which average of two billion people
Epidemiologically, in 2007 ministry of health in
718
Received: 23/11/2017 DOI: 10.12816/0043972
Accepted: 03/12/2017

Full Paper (vol.705 paper# 2)


Paper Title (use style: paper title) The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 723-727

The Knowledge and Attitude of King Abdul-Aziz University Hospital
Out Patient Clinic Visitors toward Coronavirus
Maha Al-Alalawi, Abdulilah Alsolami, Abdullah Alghanmi, Hatan Said,
Adam Alatawi, Abdullah Lhajooj
Department of Internal Medicine Medical College, King Abdulaziz University, Jeddah, KSA

ABSTRACT
Background:
The Middle East respiratory syndrome (MERS) is a virus-like respiratory disease generated by a
coronavirus (Middle East respiratory syndrome coronavirus, or MERS-CoV). Coronaviruses are capable of
causing severe transmittable infection to humans, and was primarily found in 2012 in Saudi Arabia.
Consequently, similar cases showed up in Qatar, Saudi Arabia, other Middle Eastern countries, Europe, and
the United States. Nevertheless, Saudi Arabia remains the epicenter of this dangerous respiratory infection
which is also associated with high mortality rate. Research and investigation regarding this unusual
coronavirus started as more death related cases were reported.
Objective: The goal of this research was to understand the knowledge and attitude of people of Saudi Arabia
belonging to various age groups regarding Middle East respiratory disorder and MERS-CoV.
Participants and methods:
A structured close-ended set of questions about MERS-CoV was distributed
manually and electronically to the visitors of King Abdulaziz University Outpatient Clinic which included men
and women of different ages. The questionnaire comprised items concerning methods of the transmission of
MERS-CoV infection, medical components, outcome of infection, techniques of protection and prevention,
and the accessibility of information.
Results: Out of 1000 distributed questionnaires, 876 completed ones were received and were analyzed. The
majority of respondents were of 45-65-year age group (36%). With regards to knowledge of coronavirus and
disease caused by it, the majority of respondents had sufficient knowledge about the disease (52%) and the
majority of respondents were also aware of the mode of its transmission (72%). However, most of them (58%)
were not aware that this disease is transmitted by camel and that this infection can be treated by supportive
treatment approach alone (55%). However, a large number of respondents had less knowledge with respect to
common time of disease transmission (45%), the incubation period (41%), and indication of Corona virus
antibodies as medical finding (32%). Between the two genders, the males were more informed than females.
Additionally the married and the youth had much more information about the infection as compared to the
singles and older adults. The difference of knowledge was statistically significant (p<0.05). The major sources
of information among majority of respondents were social media (58%).
Conclusion:
At the end of this study, it was found that the amount of knowledge about MERS-Corona Virus
amongst the Saudi population was relatively low and needs to improvement. Different kinds of awareness
seminars and consulting camps should be conducted at local level. Also, direct communication with the
physicians and doctors should be made more accessible and easy in order to increase authentic knowledge
between general populations.
Keywords: MERS; MERS-CoV; KAAU; Corona; Coronavirus; KSA.


INTRODUCTION

The "Middle East Respiratory Syndrome
which caused mortality in a large number of the
Coronavirus" (MERS-CoV) is a profoundly
cases [3]. A few patients acquired gastrointestinal
dangerous, viral respiratory infection that was first
signs and symptoms, including diarrhea, nausea,
reported in Saudi Arabia in 2012. It is a causative
and vomiting. Vulnerable patients, such as elderly
agent for a dangerous type of respiratory tract
or those with preexisting respiratory diseases,
contamination which is associated with high fatality
developed sever pneumonia, kidney failure, and in
in some cases. Subsequently, the virus spread to a
worse case, respiratory failure. The medical
few other nations, including Qatar, Oman Jordan,
symptoms of MERS range from asymptomatic or
the United Arab Emirates, Kuwait and the United
mild illness to sever respiratory distress disorder and
States. Camels were found to be the source for
multi-organ failure leading to death. The incubation
MERS-Corona Virus, and it has been related to
time for MERS (time between appearance to
direct and indirect transmission to people [1]. The
MERS-Corona Virus and appearance of symptoms)
large majority of infected patients with MERS-CoV
is between 5 to 14 days [2].
developed an extreme intense respiratory pathology,
In 2012, Health Deputy Minister of the Saudi
with fever, shortness of breath, dyspnea, and cough
Arabian, Ziad Memish, stated the discovery via the
723
Received: 20/7/2017 DOI: 10.12816/0043973
Accepted: 29/7/2017


Full Paper (vol.705 paper# 3)


c:\work\Jor\vol705_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 728-730

Rectosigmoid Adenocarcinoma That is Synchronous with an Anal
Fistula (Case Report) in Saudi Arabia
Mahdi Y AlYousef 1, Riyadh Hakami MD 2, Hassan A Al Wtayyan 1, Mustafa A Bo Khamseen 1
1: King Faisal University Al Ahsa, 2: King Faisal Specialist Hospital and Research Center, Riyadh

ABSTRACT
Rectosigmoid mucinous adenocarcinoma that is Synchronous with an anal fistula is a very rare condition thus
its diagnosis and management are challenging. Here, we showed the diagnosis and management of a single case
for a 57-year-old Saudi male presented with low rectal mass and gluteal abscess and a history of recurrent
perianal abscesses that was managed as benign tumor and without a family history of neoplasms of re colorectal
parts. After reviewing the literature concerning the aetiopathogenesis of this case and the suggested treatment.
The clinical examination showed a perianal fistula and a digital rectal examination was conducted after incision
and drainage of the right gluteal abscess then rigid sigmoidoscopy was performed and biopsy was collected
showing invasive moderately differentiated adenocarcinoma. The decision was to avoid radiation preoperative
due to abscess and extensive perianal disease and a treatment plan was initiated and the patient was followed up
with regular CT examination.
Keywords: Synchronous, Rectosigmoid adenocarcinoma, anal fistula, KSA.

INTRODUCTION
revealed the presence of a longstanding perianal
Rectosigmoid mucinous adenocarcinoma that is
fistula. The patient underwent right gluteal abscess
Synchronous with an anal fistula is a very rare
incision and drainage (I&D) with pus 30-50 cc with
condition. Diagnosis of such cases is challenging
a big cavity communicating with an external opining
especially when the presenting complaint assembles
in the Rt side near the anal canal. Digital rectal exam
a benign chronic lesion of anal fistula. Management
(DGE) done in the operating room (OR) showed that
of such cases remains controversial. We present a
there was a mass felt 10cm from anal verge that was
case that has rarely been reported in Arab countries.
soft and mobile. With the use of laparoscopic
A chronic anal fistula that presents repeatedly with
technique, no peritoneal nodules were found
perianal abscess that later was found to be
diversion colostomy was done. Rigid sigmoidoscopy
synchronous
with
rectosigmoid
mucinous
was preformed and biopsy was taken from the lower
adenocarcinoma
treated
with
extralevator
rectal mass.
abdominoperineal resection (1).

An anal fistula that is persistent and recurrent causes
Surgical Pathology Diagnosis showed of 1-Low
inflammation that can lead to primary cancer, in
rectal mass, biopsy
0,1% of all anal fistulae cancer will develop (1, 2).
Invasive
moderately
differentiated
This case emphasizes the importance of further
adenocaranoma, right gluteal skin, skin with dermal
investigation of recurrent perianal abscesses and the
fibrosis extending to underlying fat associated with
need for biopsy of anal fistula (3).
mild chronic inflammation and the pathology was

negative for malignancy.
CASE PRESENTATION
After the surgery CT CAP and colonoscopy were
A 57-year-old Saudi male known case of diabetes
ordered. CT reported that there was a Right gluteal
mellitus (DM) type 2 presented to our general
region collections with connecting tracts to perianal
hospital for investigation as a case of low rectal
and perineal regions. No intra-abdominal or pelvic
mass and gluteal abscess.
collection. Circumferential wall thickening of the
There was no family history of colorectal neoplasia.
mid rectum representing the previously known
The patient had recurrent perianal abscess that was
tumor thus pelvic MRI is recommended (Fig. 1).
treated as a benign condition. Clinical examination
728
Received: 25/10/2017 DOI: 10.12816/0043974
Accepted: 05/11/2017


Full Paper (vol.705 paper# 4)


c:\work\Jor\vol705_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 731-738

The Relation between Serum Homocystiene Level and Recurrent
Abortion in Egyptian Women
Doaa M Abd- Ellatef1, Gehad A Beteha1, Manal M Hasan2and Manal A Eid3
Biochemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University1,
Obstetrics and Gynecology Department, Faculty of Medicine Tanta University2,
Clinical Pathology Department, Faculty of Medicine Tanta University3
*Corresponding author: Gehad A Beteha, E-mail address:gehadarafa87@yahoo.com

ABSTRACT
Background:
Early pregnancy loss is defined as the termination of pregnancy before 20 weeks'
gestation or with a fetal weight of <500 g. Of those that are recognized, 15-20% result in spontaneous abortions
(SABs) or ectopic pregnancies. Approximately 5% of couples trying to conceive have two consecutive
miscarriages, and approximately 1% of couples have three or more consecutive early pregnancy loss. Increased
levels of homocysteine may be due to inadequate dietary intake of folate and vitamin B12 and inherited defects
within the methionine-hmocysteine pathway such as MTHFR c677T gene polymorphism.
Hyperhomocysteinemia is associated with the syndromes of repeated miscarriage.
Objective: The aim of the current study is to estimate the serum levels of Homocystine and vitamin B12 and
their relation to prevalence of recurrent spontaneous abortion in pregnancies with history of recurrent
miscarriage. Subjects and Methods: In this study 80 pregnant women classified into two groups: GroupI:60
consecutive pregnant women who had suffered from two or more miscarriages, and Group II: 20 pregnant
women with no history of abortion .The following estimations were done (for each woman in the study): serum
homocysteine and vitaminB12 were estimated using ELISA technique. Results: Results showed a significant
increase in serum level of homocysteine in the first group compared to control group(p<0.0001) and a low
serum level of vitamin B12 which was significantly decreased in the study group (group 1) compared to control
group(p<0.0001). Moreover, Our results showed a negative correlation between homocysteine and vitamin B12.
Conclusion: The elevated serum homocysteine levels during pregnancy were significantly associated with
recurrent pregnancy losses. Moreover, reduced serum vitamin B12 level was considered a risk for recurrent
miscarriage. Homocysteine is most sensitive and specific
parameters in the recurrent pregnancy losses.
Keywords: Recurrent pregnancy losses, Homocysteine, Vitamin B12.

INTRODUCTION


Recurrent miscarriage is classically defined
causing abruption (4). Hyperhomocysteinemia is
as the loss of three or more consecutive pregnancies
therefore a possible risk factor for coronary artery
before the 20th gestational weeks. Some experts
disease. Coronary artery disease occurs when an
consider two consecutive pregnancy losses is
atherosclerotic plaque blocks blood flow to
sufficient for the diagnosis of RM because the
the coronary arteries(5).
recurrence rate and risk factors are similar to that
Hyperhomocysteinemia has been correlated
after three losses (1). Spontaneous pregnancy loss is
with the occurrence of blood clots, heart attacks,
a surprisingly common occurrence, approximately
strokes and has also been associated with early
15% of all clinically recognized pregnancies result
pregnancy loss and with neural tube defects(5).
in pregnancy failure, there are many pregnancies
The placentas with hyperhomocysteinemia
that fail prior to being clinically recognized (2).
were found to have infarction, retroplacent
The etiology of recurrent pregnancy loss (RPL)
alhaematoma,
and
uteroplacental
vascular
include
uterine
abnormalities,
chromosomal
thrombosis (6). Plasma homocysteine levels are
abnormalities, endocrine disease, alloimmune
elevated in vitamin B-12 and, vitamin B-6 and
abnormalities, autoimmune disease, thrombophilia
in folic acid deficiency(7). Vitamin B12 deficiency
and infection (3).
can affect the pregnancy outcome for both mother
Elevated homocysteine concentrations may be
and the offspring. For women who want to get
associated with some fetal abnormalities and with
pregnant, a vitamin B12 deficiency is considered an
potential blood vessel problems in the placenta,
731
Received: 15/10/2017 DOI: 10.12816/0043975
Accepted: 25/10/2017

Full Paper (vol.705 paper# 5)


c:\work\Jor\vol705_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 739-744

Meta-Analysis Study on Alcoholic Liver Cirrhosis
Hussam Musallam Alfarsi 1, Abdullah Obaid Binobaid 2, Thamer Saeed Alghamdi 1, Fedaa Hussain
Albeladi 3, Hassan Talal Abdulaziz Alqudaihi 4 , Eman Ahmed Hassan Alabdrabalrasol 4 , Umaima
Ibrahim Khalfan Al Barashdi 5 , Mohammed Ali Mohammed AlSaghirat 4 , Hayfa ahmed Hassan 3,
Qusai Abdullah Alsaqabi 6 , Ahmad Fahad Eid Al-Rashidi 7 , Fahad Yahya Ahmad Hakami 8
1- King Abdulaziz University, 2- Alfaisal University, 3- Arabia Gulf University,
4- Imam Abdulrahman bin Faisal University, 5- Maabaila HC, Muscat, 6- Aljouf University,
7- Al Adan Hospital, Internal Medicine Department, Kuwait, 8- Sabia PHC

ABSTRACT

Background: Heavy alcohol consumption is an inevitable cause of alcoholic liver disease with a high chance to
progress to Alcoholic Liver Cirrhosis. Alcohol could damage the function of body organs and could cause
cancer. Liver damage due to excessive alcohol consumption is usually presented as fatty liver (build-up of fats
in the liver), steatohepatitis, fibrosis, alcoholic cirrhosis, and hepatocellular carcinoma. When liver fibrosis
progresses, it will ultimately end up as alcoholic cirrhosis.
Objective of the Study: This article was intended to explore and investigate the possible optimal diagnosis and
management of Alcoholic liver cirrhosis.
Methods: We searched the medical literatures to retrieve studies for the review till 30 November 2017.
Electronic search in the scientific database from 1965 to 2017 (Medline, Embase. The Cochrane Library
websites were searched for English Publications (both reprint requests and by searching the database).
Data extracted included authors, country, year of publication, characteristics of patients, pathophysiology, risk
factors, clinical manifestations, different diagnostic approaches and treatment modalities.
Conclusion: Absolute abstinence remains the foundation for any treatment of any acute or chronic Alcoholic
Liver Disease. It's also important to understand that no treatment will cure cirrhosis or repair scarring in the
liver that has already occurred and the only resort would be liver transplantation which is also debatable
provided the complications it carries along. Nevertheless, timely diagnosis of alcoholic cirrhosis in people with
alcoholic liver disease is the cornerstone for evaluation of prognosis or choosing treatment strategies such as
nutritional and medical support and lifestyle change.
Keywords: Alcohol consumption, Cirrhosis, alcoholic liver diseases, fibrosis, steatosis, steatohepatitis, treatment,
live transplantation, chronic liver diseases.

INTRODUCTION

Heavy alcohol consumption causes alcoholic liver
alcoholic cirrhosis in women compared with the
disease and is a causal factor of many types of liver
Danish general population.
injuries and concomitant diseases. It is a true
However, there was no further dose response
systemic disease that may damage the digestive tract,
relationship and no additional risk for drinking a
the nervous system, the heart and vascular system,
much higher volume than 60 g day-1[3].
the bone and skeletal muscle system, and the
Abstinence from alcohol may help people with
endocrine and immune system, and could lead to
alcoholic disease in improving their prognosis of
cancer [1].
survival at any stage of their disease; however, the
Alcohol-related liver disease is linked to the pattern
more advanced the stage, the higher the risk of
of alcohol consumption [2].
complications, co-morbidities, and mortality, and
90% -100% of heavy drinkers develop fatty
lesser the effect of abstinence. Being abstinent one
liver disease.
month after diagnosis of early cirrhosis will improve
10% -35% of heavy drinkers develop alcoholic
the chance of a seven-year life expectancy by 1.6
hepatitis.
times [4]. Liver transplantation is the only radical
8%- 20% of heavy drinkers develop alcoholic
method that may change the prognosis of a person
cirrhosis
with alcoholic liver disease; however, besides the

difficulties of finding a suitable liver transplant
In 2004, a Danish group [3] concluded, that there
organ, there are many other factors that may
was a threshold seen at a consumption level of
influence a person's survival [5].
greater than five drinks (60 g of pure alcohol) on
The liver is the main site of alcohol metabolism
average per day.
acting through two hepatic enzymes, alcohol
People drinking that heavily had an increase in the
dehydrogenase and cytochrome P-450 (CYP) 2E1.
rate of mortality by 27 times from alcoholic cirrhosis
Increased alcohol intake disrupts metabolic liver
in men and a 35-fold increased mortality from
function, and, as a result, alcoholic liver disease

develops [6].
739
Received: 25/10/2017 DOI: 10.12816/0043976
Accepted: 05/11/2017

Full Paper (vol.705 paper# 6)


c:\work\Jor\vol705_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 745-753

Psychological Interventions for The Management of
Bipolar Disorder
Saeed Khalil Saeed bin Jabal 1, Khalid Ibrahim S Albulushi 2, Mohammad Ehsan M Shokri 2,
Maan Ahmed Alsaaid 1, Abdulrahman Mohammed M Aloufi 3, Rawan Abdullah Alsaedi 4,
Fatimah Radi Slais 5, Hasan Sharif H Bukhari 6, Abdulaziz Khalid M Addas 2,
Turki Ali Abdullah 7, Bayan Mohammed AlKhalili 8, Wisam Hassan Y Fatani 9
1- Arabian Gulf University, 2- King Abdulaziz University, Jeddah, 3- King Khalid University,
4- King Fahad Hospital, 5- Alamal Complex, Dammam, 6- Umm Al-Qura University,
7- Abha Psychiatric Hospital, 8- Ibn Sina National College, 9- Batterjee Medical College

ABSTRACT

Background: Bipolar disorder is a chronic relapsing and mostly severe psychiatric disorder accompanied with
a significant psychiatric comorbidity, considerable role impairment, and significant risk of suicide attempts
according to recent researches. Mood stabilizers and antipsychotic medications have proved to be effective in
managing symptoms for many patients. Nevertheless, medication noncompliance for some patients is a raising
concerns. Additional risk for increased symptom severity and relapse when subjected to high levels of
psychosocial stress, such as living in a negative family environment has also been reported. Psychosocial
treatments, such as cognitive-behavioral therapy (CBT) and family-focused therapy (FFT) were hence
introduced in hope of an integrated strategy for the management of bipolar disorder.
Objective of the Study: This article is intended to review the optimal approach for the management of bipolar
disorder. Advances in biopsychosocial treatments are also briefly reviewed, including new health service
models for providing care.
Methods: Electronic search in the scientific database from 1960 to 2017 The studies in this comprehensive
review were selected for inclusion based on clinical relevance, importance, and robustness of data related to
diagnosis and treatment of bipolar disorder. The search terms that were initially used on MEDLINE/PubMed
and Google Search terms included bipolar disorder, mania, bipolar depression, mood stabilizer,
atypical antipsychotics, and antidepressants. High-quality, recent reviews of major relevant topics were
included to supplement the primary studies.
Results: Bipolar disorder is a major public health concern. Management includes a lifetime course of
medication and attention to psychosocial issues for patients and their families. Standardized treatment
guidelines for the management of acute mania have been developed. New potential treatments are being
investigated.
Conclusion: Bipolar disorder have a very dynamic and chronic nature and thus, careful selection of a
treatment should be tailored to the phases of the disorder, together with the safety profile identified in clinical
trials. Nevertheless, Psychosocial interventions, such as CBT and FFT should be employed in combination
with pharmacological therapy for bipolar patients in order to increase medication compliance, decrease
depressive symptoms and recognize early warning signs of an affective episode should ideally help to optimize
the course and outcome of this devastating condition.
Keywords: Bipolar disorder, Mania, depressive episodes, Psychological Interventions.

INTRODUCTION

Bipolar disorder is a well-known chronic illness
2. Bipolar disorder II: characterized by episodes of
defined by recurrent episodes of manic or
depression and hypomania.
depressive symptoms, with intervening periods that

are comparably yet not completely symptom-free.
Hence, the main difference between the 2 types is
Bipolar disorder has a lifelong impact on patients`
the severity of manic symptoms: full mania causes
overall health status, quality of life, and functioning
severe functional impairment, can include
(1). Onset occurs usually in adolescence or in early
symptoms of psychosis, and often requires
adulthood, although onset later in life is also
hospitalization; hypomania, by contrast, is not
possible (1). BP disorder has 2 the following main
severe enough to cause marked impairment in
types according to the American Psychiatric
social or occupational functioning, or to necessitate
Association (2):
hospitalization (2).
1. Bipolar disorder I: defined by episodes of
Bipolar disorder has an enormous economic
depression and the presence of mania.
impact worldwide, taking the US as example (3), the

estimated total direct cost of bipolar disorder
745
Received: 24/11/2017 DOI: 10.12816/0043977
Accepted: 04/12/2017

Full Paper (vol.705 paper# 7)


c:\work\Jor\vol705_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 754-761
Meta-analysis on Corneal Changes following Phacoemulsification in
Diabetic vs. Non-diabetic Cataract Patients
Faisal Ali A Alotaibi 1, Rawan Ariman Alosaimi 2, Fatimah Hassan Alyahya 3,
Mohammad Mustafa Alali 4, Faris Ali Nasser Ayidh 5, Farhan Musafiq Alanazi 6,
Faisal Fahad Alanizy 7, Nora Faisal Alsaud 8, Ahmad Sami A Himayda 9, Nouf Awad S Albalawi 10,
Wissam Abdullatif Alsuwailm 11, Mohammed Abdullah M Alamri 3
1- King Abdulaziz Specialist Hospital, Taif, 2- Jordan university, 3- King Abdulaziz University,
4- Imam Abdulrahman Bin Faisal University, 5- King Khalid University, 6- Aljouf university,
7- King Saud Bin Abdulaziz University for Health Sciences, 8- Alfaisal University,
9- Umm al-Qura University, 10- Tabuk University, 11- King Faisal University

ABSTRACT
Aim of the Study:
was to investigate the influence of phacoemulsification on corneal endothelial cells and
its injury risk factors in diabetic cataract patients and non-diabetic patients.
Methods: electronic databases were searched: Scopus, EMBASE, and Google Scholer), PubMed/MEDLINE,
Scopus, The Cochrane Library, and Web of Science. Econlit from 1990 to 2017. This was completed with a
manual search of references of relevant papers. Risk of bias in methodology of studies was measured using the
Newcastle-Ottawa Scale.
Results: Observation of corneal endothelial cell density, coefficient of variation and percentage of hexagonal
cells preoperatively, 1 day, 1week, 1 and 3 months postoperatively was carried out, and multiple Logistic
regression analysis for risk factors of corneal endothelial cell injury was taken.
Results: Out of 779 retrieved papers, 9 studies with a total of 1129 individuals were finally included (579
diabetic eyes and 550 non-diabetic eyes). For the dynamic changes between preoperative and postoperative
values, significant differences were identified between the two groups in endothelial cell density (ECD) and
hexagon cells (HC%) at 1day, 1 week, 1 month, and 3 months postoperatively, in central corneal thickness
(CCT) at 1 month postoperatively, and in coefficient variation (CV) at 1 week and 1 month postoperatively.
However, no significant differences were observed in CCT at 1day, 1 week and 3 months postoperatively or in
CV at 1day and 3 months postoperatively.
Conclusion: it could be concluded from the current literature that aged-cataract patients with diabetes mellitus
manifested poor tolerability to cataract phacoemulsification surgery in contrast to senile cataract patients.
Keywords: Phacomulsification, cataract, DM, corneal changes.

INTRODUCTION
reversible in young diabetics with improvement in
Worldwide more than 285 million people are
metabolic control. The most frequently seen type of
affected by diabetes mellitus. This number is
cataract in diabetics is the age-related or senile
expected to increase to 439 million by 2030
variety, which tends to occur earlier and progresses
according to the International Diabetes Federation [1].
more rapidly than in nondiabetics.
Several clinical studies have shown that cataract
Many publications supported the hypothesis that
development occurs more frequently and at an
the initiating mechanism in diabetic cataract formation
earlier age in diabetic compared to nondiabetic
is the generation of polyols from glucose by AR,
patients [2].
which results in increased osmotic stress in the lens
Data from the Framingham and other eye studies
fibers leading to their swelling and rupture [4].
indicated a three to fourfold increased prevalence of
In addition to diabetic retinopathy, diabetic patients
cataract in patients with diabetes under the age of 65,
are more susceptible to developing corneal endothelial
and up to a twofold excess prevalence in patients
damage, keratoepitheliopathy, persistent epithelial
above 65[3]. The risk is increased in patients with
defects, and superficial keratitis [5].
longer duration of diabetes and in those with poor
Phacoemulsification
with
intraocular
lens
metabolic control. A special type of cataract--
implantation is one of the most famous surgical
known
as
snowflake
cataract--is
seen
procedures carried out to cataract patients. The
predominantly in young type 1 diabetic patients and
patients are mostly elderly which usually adds a
tends to progress rapidly. Cataracts may be
negative impact to the surgical outcome behind
754
Received: 25/10/2017 DOI: 10.12816/0043978
Accepted: 05/11/2017


Full Paper (vol.705 paper# 8)


c:\work\Jor\vol705_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 762-765

Abnormal Uterine Bleeding in Women in Child Bearing Period of Arar
City, Northern Saudi Arabia
Shoug Zeid Trad Alenezi, Reem Faleh Abdullah Alanazi, Anwar Eid Mohammed Alruwaili,
Najah Dhaher Yahia Alanzi, Maha Mukhlef Ramadan Alanazi, Reem Hulayyil Alanazi,
Marwah Khaled Ibrahim Altawyan, Zuhur Dhaher Munahy Alfuhigi, Maha Hazzaa Fraiwan Alshalan,
Atheer Bader Faihan Alanzi, Reem Hamoud Sulaiman Alshammari,
Waad Hameed Altarfawi, Ohud Falah Munukh Alanazi
Faculty of Medicine, Northern Border University, Arar, KSA

ABSTRACT
Background:
Abnormal uterine bleeding (AUB) affects as many as one-third of reproductive-aged women.
Women with AUB may experience pain, embarrassment and inconvenience that can have a significant impact
on their lives. This study was carried out aiming to assess the pattern and possible causes of abnormal uterine
bleeding in reproductive aged women in Arar city, Northern Saudi Arabia. Methods: The study was conducted
at Maternal and Child Hospital of Arar City, during the period from 1/5/2017 to 30/7/2017. Data collected by
personal interview with cases and filling a pre-designed online questionnaire. Collected data was coded and
analyzed using statistical package for the social sciences (SPSS, version 16). Descriptive statistics for the
quantitative and qualitative variables were used. Results: In our study 100 women were included, with mean
age 30.56.9, mean age of menarche was 13.1 (1.8) and 52% of them had regular menses. Pattern of
bleeding was menorrhagia in 52%. The cause of bleeding was dysfunctional uterine bleeding in 59% of cases,
Intrauterine device complications in14%, Uterine fibroid in 12% of cases and contraceptive pills complications
in 15%. Only 13% of them treated surgically while 87.0% treated medically. Conclusion: The most common
cause of abnormal uterine bleeding was endometrial hyperplasia (in 59%), and the contraceptive pills
complications comes in the second place (in 15%), then the Intrauterine device complications (in 14%) and the
uterine fibroid (in 12%). Health education sittings is recommended to increase the public awareness about the
causes and importance of seeking medical care during AUB attacks specially in premenopausal period.
Keywords: Abnormal uterine bleeding; Child bearing period; Arar City; Saudi Arabia.


INTRODUCTION

Abnormal uterine bleeding affects as many as one-
pain, inconvenience and ritualistic behavior, it
third of reproductive-aged women[1]. Indeed, women
although had effect on the cost of
of reproductive age are much more frequently
economy and health service [10]. AUS study reported
affected by AUB than premenarchal or menopausal
financial losses annually of >$200 per patient due to
women [2]. There are many types of abnormal uterine
work absence and home management costs [11].
bleeding according to amount, duration or timing of
AUB is common in developing countries as they are
bleeding , and it can be acute or chronic [3]. About
in developed countries, and that when services are
9%-46% of women report AUB during their life [4, 5].
available, this will prompt women in developing
Not surprisingly, women with AUB report a
countries to seek care for them [12], and many of girl
significantly poorer quality of life when compared to
are suffering from lack of information or no
unaffected women of similar ages [6]. Such bleeding
information about AUB [13].
can occur as normal physiological event in
The report of Houston et al. showed that twice many
adolescents establishing menses and women
African-American adolescents compared with
experiencing perimenopause, or it can be as
Caucasian teens felt un prepared and didn't receive
pathological problem in case of any bleeding with
information about menarche [14].
excessive duration, frequency, and amount in pre

and postmenopausal women.
AIM OF THE STUDY
AUB could be due to several reasons such as
To assess the pattern and possible causes of
organic (endometrial polyps, hyperplasia, myomas,
abnormal uterine bleeding in reproductive aged
atrophy, endometrial cancer or ectopic pregnancy)
women in Arar city, Northern Saudi Arabia.
or non-organic causes (dysfunctional uterine

bleeding) [7]. It's called chronic AUB when the
MATERIALS AND METHODS
bleeding from the uterine corpus that's abnormal in
This study was conducted at Maternal and child
volume, regularity or timing has been present for the
hospital of Arar City, Obstetrics and Gynecology
majority of the last 6 months [8]. As AUB has direct
department during the period from 1/5/2017 to
impact on women live as they complain from
30/7/2017. The study included 100 patients in child

762
Received: 26/11/2017 DOI: 10.12816/0043979
Accepted: 06/12/2017

Full Paper (vol.705 paper# 9)


c:\work\Jor\vol705_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 766-770

Mental Illnesses Stigma and its Association with Quality of
Life in Adult Saudi Patients
Abdullah Ahmad Al Mulhim1, Hassan Ali Y Al Dehneen2, Mohammed Riyadh A Alabbad2,
Nedal Mohammed Alhababi2, Ali Mohammed H Alhijab2, Jafar Yassen Almomaten2,
Saoud Sultan3, Aqeel Ghassan A Alhashem2, Hasan Muneer M Albahrani2, Ali Hussain Alluwaym2,
Abdullah Mohammad Almarzooq2, Qasem Mohammed Alhababi2,
Hussain Abdullah Abu Zaid4, Mohammed Nasser Alrasasi2

1 Consultant Psychiatrist, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University,
Dammam, 2 Imam Abdulrahman Bin Faisal University, 3 Consultant Psychiatrist, North East London NHS
Foundation Trust, 4 Arabian Gulf University

ABSTRACT
Background:
Mental health patients with self-stigma often loss their self-esteem.
The objectives: This study was conducted to determine the prevalence rate of mental illnesses stigma and its
association with quality of life in adult Saudi patients attending the out patients in psychiatry department in
King Fahad University Hospital at Al Khobar, KSA. Methods: This is a cross sectional study. A
demographic data including age, sex, marital status and occupation were collected in addition to a 32
question-based questionnaire with different variables divided into three parts; To gain further perspective on
discrimination experienced by persons with mental illness. To study rejection experienced by mentally ill
patients. To evaluate the patients coping ways to stigma which characterized by secrecy, avoidance and
withdrawal, and advocacy and confrontation. Results: There were 71 (34.6%) women, 112 (54.6%) men.
About third (36.6%) of respondent agrees that people think of mentally ill patients as untrustworthy. Almost
half of them (44.9%) disagree that people find them dangerous. The same percent (44.9%) agree that people
take them less seriously.41.5% of them feel that people avoid them. More than half of them 51.2% disagree
that someone will not take them as close friend. But 54.6% didnt feel any avoidance from relative,
neighbors or colleagues (missing data 11.2%). 67.8% also, didnt feel any avoidance from family members.
More than half (55.1 %) tries to hide the fact that they are mentally ill and 72.2% will not avoid getting
married or starting a family because of their mental illness history. Conclusion: Our study indicated that
most of mental health patients in our community have experienced moderate to severe level of stigma.
Future researches are needed to study the prevalence of stigma and rejection in mental health patients allover
Saudi Arabia. Community awareness campaigns to raise the knowledge that mental illness is a disease like
other body diseases and there is no shame of being mental health patient.
Keywords:
Mental Illnesses; Stigma and rejection; Quality of Life; Saudi Arabia

INTRODUCTION

negative impacts is disturbance of the patient from
Self-stigma has a fatal influence on mental
seeking care and treatment commitment [5].
health patients lives [1]. When we talk about
Mental health patients with self-stigma often
stigma, Goffman conception about stigma is
lose their self-esteem [6]. Satisfaction with work,
usually used. In 1963 Goffman defined stigma in
health and finance were associated with self-
his book as "the process by which the reaction of
stigma and self-esteem [7].Multiple researches
others spoils normal identity" [2,3]. Individual
were published to study the discrimination and
stigmatization leads to the feeling of shame and
stigmatization that associated with mental illness.
the belief that the individual does not belong to the
Mental illness are mostly linked to the devil in our
public1. Although stigma has been studied by
community [8].
many researchers since tens of years, it is still one
In Saudi Arabia, up to our knowledge, there is
of the common health problems facing the
a defect in tackling the stigma of mental illness.
community [2]. People who are mentally ill are
The study question: Does Saudi mental
among the most stigmatized groups in society.
health patients have stigma?
Goffman thought that mental illness is the most
The objectives of this study were to determine
discountenance between all stigmas [4]. The benefit
the prevalence rate of mental illnesses stigma and
beyond understanding what is stigma is to reduce
its association with quality of life in adult Saudi
the negative impact of it. One of the important
patients attending the out patients psychiatry
766
Received: 26/11/2017 DOI: 10.12816/0043980
Accepted: 06/12/2017

Full Paper (vol.705 paper# 10)


c:\work\Jor\vol705_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 771-776

The Correlation Between Infants' Congenital Heart Defects and
Maternal Folic Acid Supplementation
Alruwaili Fahad Saleh Hassan 1, Basmeh Mohammed I Howsawi 2, Muayad Youssof Al Awwas 3,
Zainab Hassan Alzein 4, Farhan Musafiq Alanazi 1 , Haya Hussain Faqehi 5 , Ehab Osama Mugharbal 6 ,
Muath Ayidh Alrehaili 7 , Khalid Ahmed Abdullah Alshehri 8 , Reem Adel Buzeid 9 ,
Khalid Jazi Alharbi 7 , Musab Abdulrahman Alrzoq 8
1- Aljouf University, 2- King Abdulaziz Hospital , 3- Alsalmanyiah PHC In Alahsa ,
4- Medical University of Warsaw, Aljouf University, 5- Jazan University , 6- Ohud Hospital ,
7- Qassim University , 8- Al Imam Mohammed Bin Saud Islamic University, 9- Imam Abdulrahman Bin Faisal
University , 7- Qassim University, 10- King Fahad Medical City

ABSTRACT
Background: Congenital heart defects (CHDs) are significant drivers of mortality and morbidity in
children, folic acid supplementation for the pregnant month during or before delivery is said to influence risk
reduction of congenital heart defects (CHDs). However, there are controversial claims and the hypothesis is
concluded from limited epidemiologic studies. Aim of the Study: Conduct a systematic review and meta-
analysis of published studies to reliably evaluate the correlation between Folic acid or multivitamins containing
FA supplementation taken during pregnancy and the risk of CHDs. Methods: A systematic review and meta-
analysis was conducted. PUBMED and EMBASE were searched to identify prospective cohort and case-control
studies that had reported on the association between 1960 and 2017.Studies conducted in primarily high-risk
populations (Case control and cohort studies) while participants in randomized controlled trials were excluded.
Results: The search yielded 10 studies published between 2000 and 2013 enrolling 13126 female participants.
These studies included only one cohort study, and nine case-control studies. The overall results of this meta-
analysis provide evidence that maternal folate supplementation is associated with a significantly decreased risk of
CHDs (RR = 0.69, 95% CI: 0.540.84). Statistically significant heterogeneity was detected (Q = 79.43, P < 0.001,
I2 = 70.2%).
Conclusion: FA supplementation during pregnancy significantly decreases the risk of CHDs in newborns.
Keywords: Folic acid, pregnancy, Congenital heart defects, Maternal Folic Acid Supplementation.

INTRODUCTION

Congenital heart disease (CHD) has been defined as a
showed that consanguinity[6], and a variety of
gross structural abnormality of the heart or
maternal ailments e.g., infections, maternal smoking,
intrathoracic great vessels that is actually or potentially
and gestational diabetes mellitus play a major role in
of functional significance. In the developed world,
the development of CHD. In addition, there are several
CHD is considered to be the most major congenital
fetal factors such as prematurity, low birth weight and
anomaly and a leading cause of mortality in the first
stillbirth which are found to be associated with CHD.
year of life[1]. Congenital heart disease (CHD) is
THE CAUSE of congenital heart disease is
present in about 9 of every 1,000 live-born children[2]. unknown except for the recognition that it may occur
Congenital heart defects (CHDs) are the most common
in certain hereditary diseases, may be associated with
structural abnormalities presenting at birth, and they
chromosomal abnormalities, and may be related to an
are also one of the leading causes of perinatal and
intrauterine viral disease such as rubella. This genetic
infant mortality[2].
and environmental interaction is most likely to be
It is reported that the prevalence of CHDs accounts
pathogenetic mechanism of congenital heart defects.
for 6% of all neonatal death factors, and also accounts
Calculations based on this hypothesis predict the
for 46% of all congenital lethal factors [3]. Recently,
frequency of occurrence of the disease in first degree
the survival of newborns with CHDs has increased due
relatives to be square root of its frequency in the
to massive breakthrough in cardiovascular diagnostics
population; this fits the congenital heart disease
and cardiothoracic surgery [4].
figures[7]. Ventricular septal defect and coarctation of
Arious studies have shown the etiology of congenital
the aorta are typical examples of CHDs. Congenital
heart disease (CHD) and its pattern of inheritance to be
heart defects are more common than well-known
of multifactorial origin[5].A review of the literatures
congenital anomalies such as congenital pyloric
771
Received: 27/11/2017 DOI: 10.12816/0043981
Accepted: 07/12/2017

Full Paper (vol.705 paper# 11)


c:\work\Jor\vol705_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 777-785

Antibiotic Prophylaxis in Plastic Surgery
Osama Talaat Khouj 1, Faisal Saud Yousuf 2, Haitham Abdullah Alnahedh 3,
Hind Mohammed Alhodaly 4, Khaled Hamad Mohammed Albaradi 4, Afnan Abdulaziz Alshaifani 5,
Fadaa Magthel H Alotaibi 6, Sahar Matter Alshammery 7, Ibrahim Ghaleb Daiwali 8, Mohammed
Ahmed Musatfa Ali 8, Norah Ahmed Ibrahim Al Mallohi 5, Jabir Mohammed A Alnabhani 4
1- King Abdul Aziz University Hospital, 2- University of Jeddah,
3- Al Iman General Hospital, 4- King Abdulaziz University, 5- Unaizah College of Medicine, Qassim
University, 6- King Khalid University, 7- Princess Noura University, 8- Battarji college of medicine

ABSTRACT
Background:
prophylactic antibiotics are effective in preventing surgical-wound infections. However, the
clarity about the compelling need for antibiotic administration and the risk associated with their use is missing.
The use of antimicrobial prophylaxis against surgical site infection (SSI) is common in plastic surgery, while
results from prospective randomized controlled trials are scarce.
Aim of the Study: was to evaluate the need for antibiotic prophylaxis in the field of plastic surgery.
Methods: Electronic search of available Literatures in the scientific database of recent randomized controlled
trials evaluating the indications for and use of antibiotics to reduce and treat SSIs for patients undergoing plastic
surgery from 1960 to 2017 (Medline, Embase, the Cochrane Library as well as NHS centre websites were
searched for English Publications from both reprint requests and by searching the database. Data extracted
included antibiotic dosage, duration and incidence of surgical site infection.
Conclusion: surgical procedures must be distinguished based on the risk of infection and the need for antibiotic
prophylaxis should be determined accordingly, i.e. on a case by case basis.No prophylaxis is required for
superficial skin's and clean surgeries such as mucosal excisions, nevertheless, Antibiotic prophylaxis is
recommended microsurgical operations, prosthetic surgery, incisional hernias, clean non-prosthetic osteoarticular
surgery, oral cavity and genitourinary system procedures.
Still, antibiotic use should be prescribed with caution to avoid profound side effects such as developing resistant
bacterial strains, severe allergies and other accompanied comorbidities.
Keywords: Antibiotic prophylaxis, Surgical site infection (SSI), Infections in plastic surgery, SSI prevention..

INTRODUCTION
A 19% decrease in SSI related to 10 select procedures
Skin is basically a natural barrier against infection
was reported between 2008 and 2013(4).
and despite many precautions and protocols to
They threaten the lives of millions of patients each
prevent infection in place, any surgery that causes a
year and contribute to the spread of antibiotic
break in the skin may in turn cause an infection.
resistance. In low- and middle-income countries, 11%
Surgical site infections (SSIs) are infections of the
of patients who undergo surgery are infected in the
incision of organ or space that occur after surgery(1).
process. In Africa, up to 20% of women who have a
Surgical site infections can sometimes be superficial
caesarean section contract a wound infection,
infections involving the skin only, however other
compromising their own health and their ability to
surgical site infections are more serious and can
care for their babies. But surgical site infections are
involve tissues under the skin, organs, or implanted
not just a problem for poor countries (5).
material. CDC provides guidelines and tools to the
Before the mid-19th Century, the majority of
healthcare community to help end surgical site
surgical patients developed SSI. The process began
infections and resources to help the public understand
with an irritative fever, followed by purulent
these infections and take measures to safeguard their
drainage from the incision as well as sepsis and death.
own health when possible(1). The CDC healthcare-
The face of surgery changed radically when Joseph
associated infection (HAI) prevalence survey found
Lister, in the late 1860s, introduced the principles of
that there were an estimated 157,500 surgical site
antisepsis, decreasing patient suffering by reducing
infections associated with inpatient surgeries in 2011
postoperative infectious morbidity substantially
(2). NHSN data included 16,147 SSIs following
(6).Since then, advances in surgical techniques,
849,659 operative procedures in all groups reported,
including better hemostasis, conservation of an
for an overall SSI rate of 1.9% between 2006-2008 (3).
adequate blood supply, hypothermia prevention,
777
Received: 27/11/2017 DOI: 10.12816/0043982
Accepted: 07/12/2017

Full Paper (vol.705 paper# 12)


c:\work\Jor\vol705_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 786-790
The Effects of Immunomodulatory Molecule- Lipoxin A4- on The
Physiology of Cystic Fibrosis Human Bronchial Epithelium
Mohammad Sindi, Magdalena Mroz
Faculty of Molecular Medicine, Beaumont Hospital
Corresponding author: Mohammad Sindi, email: mohammadhsindi@rcsi.ie

ABSTRACT
Cystic fibrosis (CF) is a disease characterised by the depletion of Airway Surface Liquid (ASL) height.
Lipoxin A4 was found to be effective in restoring ASL back to normal by acting on ENaC. The signalling
mechanisms involved in lipoxin effect were investigated by testing the action of a calcium chelator (Bapta-
AM) and Protein kinase C inhibitor (GF 109203X) on NuLi-1 and CuFi-1 cells. Drug's efficacy was
monitored by conducting Ussing chamber experiments and confocal microscopy. Results showed that calcium
has a major contribution to the lipoxin A4 effects while PKC has a limited role. However, our data might lack
accuracy due to shortage of time to conduct more experiments.
Keywords: CFTR, cystic fibrosis, genetic mutations, human bronchial, Lipoxin A4, human bronchial
epithelium.

INTRODUCTION

AIM OF THE STUDY
Cystic fibrosis is a life-threatening autosomal
The aim of this study is to further investigate
recessive disorder caused by a genetic mutation
the signalling pathways involved in lipoxin A4
involving the cystic fibrosis transmembrane
effects by measuring ion transport in Ussing
regulator (CFTR) that affects ~70,000 individuals
experiments, ASL height in confocal microscope
worldwide (1). In addition, CFTR is expressed in all
studies and monitor protein kinase C
epithelial tissue lining tubes and ducts. Thus, a
phosphorylation status by western blotting.
mutant CFTR will give rise to multiple serious

conditions such as pancreatitis, cirrhosis, meconium
METHODS
ileus and infertility (2). Among those affected by CF,
Cell culture
90% were at least carriers for one allele of F508Del
NuLi-1 (normal cells) and CuFi-1 (cystic fibrosis
genotype (3). The condition mainly affects those of
cells) were used in all experiments involved in our
European origins, although it has been reported in
studies. These cells were cultivated, immortalized
all races and ethnicities (4). CFTR dysregulation
and donated by prof. Zabner (USA) to Molecular
leads to ASL dehydration due to lack of chloride
Medicine research laboratory. In the lab, cells were
ions secretion. ASL dehydration is further increased
kept at -180 in liquid nitrogen and when it's time
by over absorption of sodium ions through
to use them, they get moved to grow in flasks to
epithelial sodium chancel (ENaC) on the apical side
achieve confluency. Subsequently, cells were
(5). This disrupts the height of Airway Surface
placed on inserts which allowed them to further
Liquid (ASL) which is kept at 7m in normal
grow and differentiate. Initially, bronchial epithelial
epithelial tissue. This layer is composed of a
growth medium (BEBM) was used for the first
periciliary liquid layer for lubrication and a mucus
week of growing. Confluency is inspected under
layer for dust and pathogens entrapment (6). ASL
microscope, and once is reached, medium is
provides optimal working conditions for cilia that
switched to DMEM-F12 to enhance cell
clear mucus. When ASL is damaged, viscous
differentiation. The culture medium was changed
secretions accumulate in the airways of the lungs
under the hood every 3-4 days. The procedure was
causing mucosal plugging that prepare favourable
repeated for up to 4-6 weeks where cells develop
conditions for bacteria to cause repeated infections
confluent monolayers, cilia and mucin secretions
(7). Although the median survival age rose for up to
with transepithelial electrical resistance of >700
37 years, the disease is still life shortening with
ohms.
obstructive lung disease being responsible for 80%

of mortality caused by CF (8).
Ussing chamber experiments
Recently, a study carried out by Alalawi et
The ringer buffer was prepared using 2.3M of
al. (9) showed a promising curative role for lipoxin.
NaCL,
KH2PO4
8mM,
NaHCO3
0.5M,
Lipoxin is an immune-modulator that can inhibit
MgCl2*6H2O 24mM, CaCl2*2H2O 24mM,
ENaC and restore normal physiological height of
Glucose 1M and 400ml of distilled water to make a
ASL in low and high concentrations.
solution of 500ml. Differentiated cells were moved
786
Received: 29/11/2017 DOI: 10.12816/0043983
Accepted: 09/12/2017

Full Paper (vol.705 paper# 13)


c:\work\Jor\vol705_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 791-795

Patients Satisfaction after Endodontic Treatment in Saudi Arabia
Yasmeen Alshammari 1, Muthhin Almuthhin 2, Alzahra Alarajah 1,
Ghaidaa Mohammed Barri 1, Hajr Alshammari 3, Sami Alshahrani 4
1. Private Sector ,2. Ministry of Health, 3. Alfarabi Dental College,
4. King Khalid University Abha
ABSTRACT
Background:
Dental anxiety and fear appear to vary according to the type of treatment. Endodontic
treatments have been shown to cause higher levels of anxiety than restorative or prophylactic treatments.
Patient's pretreatment decisions and post-treatment satisfaction may be strongly influenced by social,
psychological, and behavioral aspects including knowledge, beliefs, attitudes, preferences, and behaviors.
Aim: This study aimed at investigating the percentage of patient's satisfaction toward the endodontic
treatment done by endodontic specialists.
Methodology: Some cases (78) from different ages were asked to apply a questionnaire to show the
percentage of satisfaction toward endodontic treatment of patients received by endodontic specialists during
the year of 2017 in Saudi Arabia.
Results:
percentage of satisfaction was different among the cases toward the various steps in endodontic
treatment, but it was evident that more satisfaction was related to qualitative and proper treatment procedure
but the correlation between satisfaction and pain score was negative.
Conclusion: Patients satisfaction toward the endodontic treatment is related to different factors, some of
these factors related to the patient himself like his health status and the others depend on the nature of
endodontic procedure itself.
Keywords: endodontic; satisfaction; questionnaire.

INTRODUCTION


The pulp is the source of sensation to the teeth.
endodontic procedure steps like anesthesia, x-ray,
If the pulp has undergone irreversible pulpitis due
rubber dam, clamp, suctioning 4 .
to different causes like caries or trauma, it causes
Endodontists are specially trained to provide
severe pain that assumes endodontic treatment.
root canal treatments in a way that minimizes
Such case requires proper treatment planning to
anxiety so patients can be pain-free and healthy
produce a favorable prognosis 1 .
again 5.
Endodontic treatment is fairly predictable with
Endodontist has to be concerned with all details;
reported success rates up to 8698%. An
everything is significant to the patient from his
endodontically treated tooth should be evaluated
first visit to the clinic until the end of treatment 6,7.
clinically as well as radiographically for its root
In the present research study, the literature
canal treatment to be deemed successful 2 .
focused on all steps of endodontic treatment to
Dental anxiety and fear appear to vary
different cases , some of them are healthy, and
according to the type of treatment. Endodontic
others have chronic diseases, then the level of
treatments have been shown to cause higher levels
patients' satisfaction for each step of treatment and
of anxiety than restorative or prophylactic
the association between the disease and the
treatments. Patient's pretreatment decisions and
percentage of satisfaction. In the present study,
post-treatment satisfaction may be strongly
the discussion was carried out about means of
influenced by social, psychological, and
dealing appropriately with important factors to
behavioral aspects including knowledge, beliefs,
ensure great satisfaction to the patient: 1-
attitudes, preferences, and behaviors.
sterilization, 2-anaesthesia, 3-x-ray, 4-rubber dam,
Root canals have gained a bad reputation as a
5-clamp, and 6-suctioning, 7-time of procedure, 8-
painful experience for a long time. Patients might
pain score, and 9-treatment done by the doctor 8.
be aware of endodontic pathology but are likely to
The study was done after approval of ethical
be highly sensitized to treatment-related fear,
board of King Khalid university.
anxiety 3.

Satisfaction of patient toward endodontic
1-Sterilization
treatment is related to the patient himself and his
The most important parameter for the patient in
health status like having any chronic diseases,
the visiting of dental clinic is the feeling of safety
either, having the bad history of painful
from infection. Good dental infection control
endodontic procedure, and also related with
begins with the dentist's room itself. A well-
791
Received: 30/10/2017 DOI: 10.12816/0043984
Accepted: 10/12/2017

Full Paper (vol.705 paper# 14)


c:\work\Jor\vol705_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 796-800

Ionizing Radiation Among Saudi Females: Awareness and Staff Efforts
Mooataz Mohammed Aashi1, Danah Mahmoud Omran1,
Hisham Abdulhamid Alghanmi1, Saleh Ageel Shaheen1,
Bashair Mahmoud Magadmi1, Muath Abdulrahim Marghalani1*, Rani Ahmad Ghazi2
1Department of Medicine, King Abdul-Aziz University, Jeddah, 2Department of Radiology,
King Abdul-Aziz University, Jeddah, Saudi Arabia
*Corresponding author: Muath Abdulrahim Marghalani, E-mail: m.marghalani.s@gmail.com

ABSTRACT

Background: Radio-diagnostics has become widespread nowadays for identification of diseases, however,
a lot of patients, especially females of reproductive age lack awareness of risk factors involved with
ionizing radiations. This study aimed to assess the awareness regarding the risk of radiation exposure to
female patients and evaluation of the medical staffs' efforts to exclude pregnancy prior to sending patients
for radiology examination.
Methods: Three-part questionnaires were used for evaluation of reproductive aged female patients who
were undergoing investigations with ionizing radiations in January 2017 at Radiology Department in King
Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
Results: 43.7%, 65.3%, and 89.6% of physicians, radiologists and receptionists respectively, ask about
pregnancy while only a few of them asked about possibility of pregnancy and the first day in
last menstrual cycle of the patient. Overall, 91 % and 75.2% of patients estimated the risk of cancer from
chest radiography and CT respectively; being very small. However, 76.6% of patients correctly thought
that CT gave more amounts of radiation than X-rays and 61.3% of patients agreed that it is more important
for their physician to diagnose their condition with CT than to worry about the radiation exposure.
Conclusion: These data suggests that females have incomplete understanding about risks associate with
radiations, in addition to which most of clinical practitioners also do not ask about the possibility of
pregnancy which puts patients at a greater risk.
Keywords: Awareness; Females; Pregnancy; Risks; Radiation.

INTRODUCTION

Nowadays, ionizing radiation has become
female patients who are in the reproductive age
an important technique used for patients' imaging
for radiological examination (6). Over the last
in many diagnostic radiology and nuclear
decade, the fear regarding exposure to radiation
medicine procedures (1)..In the United States
and radiation-induced ionization has raised
alone, use of Computed Tomography (CT) has
exceedingly (7).
increased to more than 70 million scans per
A study done by Youssef et al. showed that
year (2).
large number of their participants thought that
However, little efforts are being made by the
doctors should inform their patients regarding the
healthcare providers to spread the awareness
benefits and risks of X-rays and CT scans, and
about the harmful effects of these radiations. It is
most of their participants did not appreciate the
essential for physicians to determine the
differences in the rate of radiation that patients are
awareness of the patients regarding exposure to
exposed
to
in
either
X-rays
or
CT
radiation (3). The International Commission on
scans (8). Another study revealed that the majority
Radiological Protection (ICRP) stated that each
of their participants did not know the amount of
year large numbers of pregnant women are
risks associated with radiations from CT scans
exposed to ionizing radiation (4). It is the duty of
(3). A study conducted in USA reported that
clinical physicians and health professionals to
primary
care
physicians
and
residents
discuss the risk of ionizing radiations during or
rarely explain the advantages and disadvantages
before pregnancy with their female patients who
of CT scans with their patients (5).
are in the reproductive age since these radiations
To the best of our knowledge, there is a lack
are very harmful for the developing fetus (5). Due
of adequate research to assess the level of
to the unintentional exposure of embryo to
awareness regarding the risk of ionizing radiation
radiations, some institutions demand the
exposure of female patients, especially in Saudi
documentation of pregnancy prior to sending the
Arabia.

796
Received: 30/11/2017 DOI: 10.12816/0043985
Accepted: 10/12/2017

Full Paper (vol.705 paper# 15)


c:\work\Jor\vol705_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 801-805

Classical Isolated Scrotal Kaposi's Sarcoma in Non-HIV Patient
Case report from KAUH, Jeddah, Saudi Arabia
Mohamed Emad Bayoumi
King Abdulaziz University, Jeddah, Saudi Arabia
Corresponding author: Mohamed Emad Bayoumi,Phone number: +966500820806, Email:
mohammed.e.b@hotmail.com

ABSTRACT
Background:
Kaposi Sarcoma (KS) is a rare neoplastic vascular disorder. The pathogenesis of KS
remains controversial. However, suppression of the immune response was almost necessary. Classical KS
most likely affects the male genitalia. Penile KS is the most common, while isolated scrotal KS has been
unusual to see. In this case report, we review a rare case of scrotal KS in a non-HIV patient with history,
clinical, laboratory, imaging findings.
Presentation of Case:
A 60 years old male patient, known to have ischemic heart disease. Presented with
progressive painful scrotum swelling for 3 weeks. He had dysuria and gave a history of weight loss. Not
complaining of prostate disease. By examination, there were swelling, warmness, tenderness to palpation
in his scrotum. A biopsy was taken which was shown a Kaposi sarcoma.
Discussion:
Despite it names as a sarcoma, it is not considered a real sarcoma because the tumour does not
arise from mesenchymal tissue. It arises from endothelium tissue. The pathogenesis of KS still not clearly
understood and remains controversial. However, what we know is all forms of KS are strongly associated
with HHV-8 infections. The partial or complete suppression of the immune response was almost
necessary. Therefore, KS is usually associated with HIV infection. KS of the scrotum has been reported in
non-HIV patients. Very few cases have been presented with scrotal KS. First reported case of an isolated
scrotal KS around the world was in 1976. While In 1979 had been the first time to performed total
scrotectomy and bilateral orchiectomy for scrotal KS patient. A Turkish study In 2011 reviewed only one
patient had scrotal KS out of 32 cases with HIV-negative KS in the Middle East. In this case, the patient
received 3 cycles of chemotherapy with no improvement so we preferred local excision because these
lesions were small and stable for about 3 years. After 3 years of follow-up no recurrence was observed.
Conclusion:
Classical KS is generally observed in the lower extremities, it can rarely affects scrotal skin
as isolated lesions. Thus. Genital examination should also include for those patients. In addition, the
isolated scrotal Kaposi sarcoma is absolutely cannot be cured by medication. Adjuvant chemotherapy still
in many cases show incomplete improvement. Orchiectomy might be the conclusive curative option.
Keywords: Kaposi; Sarcoma; Scrotum; HHV-8.

INTRODUCTION

Kaposi sarcoma defines as a spindle cell
presented more severe including ulceration and
tumour derived from endothelium lesions. This
multiple lesions which were extending to the
systemic disease associated with human herpes
groin, and non-misshapen nodules. Treatment for
virus 8 (HHV-8) can hump a variable clinical
these patients has included the maximising
course ranging from Less mucocutaneous disease
highly active antiretroviral therapy (HAART).
to extensive organ involvement. Kaposi sarcoma
The other patients (with HIV negative or
can be initially classified into 4 subtypes: Classic
unspecified HIV ), received a local treatment
Kaposi sarcoma, Immunosuppression-associated
performed in 55.3 % (21 out of 38) of cases.
Kaposi sarcoma, Endemic Kaposi sarcoma,
Average follow-up was 14.2 months with local
AIDS-associated
Kaposi
sarcoma
[1,2].
recurrence in two cases (2 out of 38, 5.3 %) and
A research in 2014 studied the reported cases of
distant recurrence in five cases (5 out of 38, 13.2
KS for the period 19712014. They identified 44
%). In also, 6 cases reports of genitourinary KS
reported cases of scrotal KS: 6 with HIV-
in HIV-positive patients were reported. These
seropositive patients, 29 in HIV-seronegative
cases had presented more severe including
patients, and 9 patients was unspecified HIV
discoloured nodules, multiple ulcerated lesions,
status. Excisional biopsy and histology
lesions extending to the groin area, penis
(including intralesional HHV-8 testing) were
deformity and urethral stricture deformity. More
performed in all cases to reach the correct
chemotherapy treatment endeavoured in addition
diagnosis. HIV-seropositive patients had
to a maximum dose of HAART. Penile KS is a

virus-induced neoplasm mainly affecting men
801
Received: 1/12/2017 DOI: 10.12816/0043986
Accepted: 11/12/2017

Full Paper (vol.705 paper# 16)


c:\work\Jor\vol705_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 806-817

Knowledge, Attitude and Practices About Pneumococcal Infection
among Algerian Hajj Pilgrims

Mohammed Saleh Dumyati1, Saeed Abu Bakr Balubaid1, Faisal Abdulrahman Althobaiti2,
Hani Amanullah Azizurrehman3, Basam Zuhaer Sindi1

1 Umm Al-Qura University, 2 Taif University, 3 Albattarji medical college
Corresponding author: Mohammed Saleh Dumyati - mohammed.dumyati@gmail.com - +966 59 570 0070

ABSTRACT
Background:
Hajj attendance increases the risk of respiratory infections including pneumonia.
Pneumococcal infections are caused by Streptococcus pneumonia, a gram-positive, catalase-negative
organism normally mentioned as pneumococcus. S pneumonia is the most mutual reason of community
acquired pneumonia (CAP), bacteremia, otitis media, and bacterial meningitis, in addition to a significant
cause of sinusitis, osteomyelitis, septic arthritis, endocarditis, and peritonitis. Complications of each of
these diagnoses are common. Clinical symptoms, signs and physical examination findings alone cannot
differentiate S pneumonia disease from infections caused by other pathogens.
Methods: This was a cross-sectional study among Algerian in al Hajj Pilgrimage. A sample size of 964
Algerian was collected. Data collection took place in September 2016. A structured questionnaire was
developed to cover the research objectives. The questionnaire was originally developed in English and
then translated into Arabic; its validity was reviewed by selected health care experts and professionals and
tested on a sample of the target population. Selected candidates were interviewed by trained medical
students; a brief description of the study. If they agreed to participate, the student administered the
questionnaire verbally. Almost 10 minutes were needed to complete the questionnaire. The process
continued till the required sample size was completed.
Results: All data showed that education is correlated to prevent infection and help them to deal with
patient infected with pneumococcus.
Conclusion: Before Hajj doctors must teach and inform all the participants about how to deal with any
infectious disease, particularly pneumonia.
Keywords:
Pneumococcal infections, Algerian, Hajj, S pneumonia.


INTRODUCTION

Pneumonia is a common cause of bacterial
preceded by a viral disease, there was acute start
meningitis, bacteremia, and otitis media. S
of high fever, malaise, rigors, tachycardia,
pneumonia infection is also an important cause of
pleuritic chest pain, dyspnea, tachypnea,
sinusitis, septic arthritis, osteomyelitis, peritonitis,
productive cough, and fatigue. Patients normally
and endocarditis[1]. S pneumonia remains the most
appeared ill and might seem anxious.
common bacterial cause of community-acquired
On physical examination, rales may be heard in
pneumonia (CAP).
most patients.
However, a recent study involving state-of-
Around half of all patients exhibited dullness
the-art diagnostic techniques for bacterial, viral,
to percussion, and splinting because of pain could
and fungal infections indicated that a specific
be seen. The most mutual complication of
pathogen was detected in only 38% of CAP cases.
pneumococcal pneumonia was pleural effusion. In
Of these cases, one or more viruses were retrieved
patients with concomitant parapneumonic effusion
in 23% of cases and bacteria in 11%.
or empyema, physical examination might exposed
A combination of bacterial and viral pathogens
the dullness to percussion, reduced breath sounds,
was seen in 3%. Fungal and mycobacterial
and reduced tactile fremitus at the bases. Though
organisms accounted for 1%. Human rhinoviruses
up to 40% of patients with pneumococcal
were isolated in 9% of cases and influenza virus in
pneumonia might have pleural effusion, only an
6%. S pneumonia remained the most common
expected 10% of these patients have enough fluid
cause of bacterial CAP, at 5% of patients [2].
to aspirate; of these, only 2% met the diagnostic
Pneumococcal
pneumonia
frequently
criteria for empyema [3, 4].
develops in older children and adults. Occasionally
Hajj is one of the biggest yearly gatherings

on the planet and draws in more than 2 million
806
Received: 1/12/2017 DOI: 10.12816/0043987
Accepted: 11/12/2017

Full Paper (vol.705 paper# 17)


c:\work\Jor\vol705_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 818-823

The Prevalence and Risk Factors of Persistent Pain after
Mastectomy in Saudi Females
1Fahad Mousa Maashi, 2Thuraya Yahya Moafa, 2Maria Ali Hakami,
2Mohammad Ali Mahnashi, 2Athar Mohammed Arishi, 2Mariam Mohammed Ayashi
1 King Khalid University, 2Jazan University
ABSTRACT
Background:
Chronic pain is known to develop after several surgeries including mastectomy.
Mastectomy is the surgical treatment for breast cancer. The prevalence of chronic pain after breast surgery
varied between different studies and several risk factors for developing pain were reported.
Aim:
To investigate the prevalence of persistent pain and its possible risk factors after mastectomy.
Methods:
This crosssectional study was performed by establishing online survey from October 2017 to
December2017. The study included 380 female who performed unilateral mastectomy.
Results:
Persistent pain was prevalent in 47.4% of participants whose mean age was 6312.1 years old
and mean BMI equal 28.95.2. Positive lymph node was more common in patients with pain 78.3%, more
women with pain 60.5% received radiotherapy. ALND was more common in individuals without pain
67.5%, while SN was more common in patients with pain 46.7%.
Conclusion:
The prevalence of persistent pain was high with moderate severity. Older age, high BMI,
positive lymph node, radiation therapy and SN axillary procedure were risk factors for developing
persistent pain after mastectomy.
Keywords:
Persistent pain, Mastectomy, Saudi women.

INTRODUCTION
however the most common cause is nerve
It has been accepted in the last decade that
damage which is associated with axillary lymph
chronic pain can result from surgery as a

complication [1,2], chronic pain was reported after
node dissection, and it is associated with
several types of surgery including thoracotomy
doubling in prevalence compared with cases who
[3]. The large majority of women who diagnosed
didn't perform this procedure [12].Several risk
with breast cancer perform either mastectomy or
factors of chronic pain were reported and these
breast conserving surgery [4].
risk factors can be pre-operative, intra-operative
Persistent pain after mastectomy was firstly
and postoperative, these factors including high
described by Wood et al. during 1970s [5].The
BMI, young age, presence of severe acute pain
chronic pain can be defined by several aspects
postoperatively or preoperatively, chemotherapy,
regarding
persistence
duration,
site
of
axillary surgery and radiotherapy [13]. Estimation
development and its description. Persistent
of the pain prevalence after breast surgery is
postoperative pain is defined as pain persist for
difficult as there are difference in methodology,
more than 3 months after surgery and this pain is
methodological limitations and treatments
related to the surgical site [6]. International
received by the patients [14]. The present study
Association for Study of Pain (IASP) defined the
aimed at assessing the prevalence and risk factors
chronic pain after mastectomy as experiencing
of the persistent pain after mastectomy.
chronic pain in the axilla, upper half of the arm

and the anterior aspect of thorax , the pain begins
MATERIALS AND METHODS
after quadrantectomy or mastectomy and last
Study design and participants
over 3 months [7-9).
This study was a cross sectional study which
Chronic pain after mastectomy also described as
was conducted on Saudi women who underwent
dysesthesia or paroxysms of lancinating and
unilateral mastectomy. The study was carried out
sensation burning, it is neuropathic in character
in the period from October 2017 to
[10].The pain can develop either shortly after
December2017 via internet survey to allow easy
surgery or after several months of surgery [3].It
access to the largest number.
was reported that the prevalence of chronic pain
The exclusion criteria for this study included
after breast surgery was 25-60% and it was a very
active breast cancer recurrence, metastasis, breast
common problem [6], with variation in the
reconstruction and bilateral mastectomy. We
severity [11). Chronic discomfort after surgery is
obtained 490 surveys, 380 of them were included
attributed to complex and varied reasons,
as they met the inclusion criteria and 110 were
excluded.The questionnaire included several
818
Received: 2/12/2017 DOI: 10.12816/0043988
Accepted: 12/12/2017

Full Paper (vol.705 paper# 18)


c:\work\Jor\vol705_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 824-827

Knowledge, Behaviors, and Attitudes about Noise-induced Hearing Loss
among Adults in Albaha Region: A Cross-sectional Study
Raed A.M. Alzahrani1, Abdulrazaq O.S. Alzahrani1, Abdulrahman A.M. Alghamdi1, Ali M.A.
Alamri1, Abdulrahman H.A. Alghamdi1, Saleh G.S. Alghamdi2, Fares A.M. Alzahrani1
1Faculty of Medicine, Albaha University, Albaha, 2Faculty of Medicine, King Abdulaziz University,
Jeddah, Saudi Arabia

ABSTRACT
Background: Worldwide, more than one billion people are affected by hearing loss. Noise-induced
hearing loss (NIHL) is reported among the most prevalent occupational diseases. However, little is known
about the current level of knowledge and attitude towards NIHL among general population.
Objective
: The purpose of this study was to investigate the knowledge, behaviors, and attitudes of adult
population in Albaha Region of the Kingdom of Saudi Arabia concerning the factors that contribute to
Noise-induced hearing loss (NIHL) and the use of hearing protection.
Methods:
A 16-item self-administrated questionnaire was used to measure the knowledge, habits,
attitudes, and perception of NIHL and each participant's use of hearing protection. The questionnaire
included multiple choice and fill-in-the-blank format questions. The questionnaire was divided into two
sections: 1) demographic information, including age, sex, college major, and prior coursework regarding
hearing in noise; 2) knowledge of hearing, the auditory mechanism, and noise-induced hearing
impairment.
Results: we received 296 valid responses. Fifty-nine percentage were male, 37 % percentage were
students, 21 % were soldiers and 17 % were teachers. Only 19 % said that hearing loss cannot be cured and
53 % knew that it can happen at any age. Interestingly, 94 % never wore an ear plug before.
Conclusion: Our study showed low percentage of correct answers about causes and protective measures
against hearing loss. Future health care program should consider initiatives and public health campaigns to
improve the public's knowledge and attitude.
Key words: knowledge, noise-induced hearing loss, Saudi Arabia.

INTRODUCTION

Worldwide, more than one billion people are
Although it is one of the most widespread
affected by hearing loss(1). Noise-induced
disabilities in Westernized society, little is
hearing loss (NIHL) is reported to be the most
known about the current level of knowledge and
prevalent occupational disease in the United
attitude
towards
NIHL
among
general
States(2). Interestingly, it has been estimated that
population.
one-third of all cases of hearing loss can be
A previous cross-sectional study by
attributed to noise exposure and that it is the
Crandell et al.(5) included 200 college-aged
most common preventable cause of hearing
young adults, and concluded that this group of
loss(3).
population exhibited considerable knowledge
The effect of NIHL represents an increasing
about the effects of noise on the auditory system.
burden on both the individual and society. The
Yet, their findings also provided evidence that
financial burden to society is significant and
there should be concern about educating young
continues to rise, with an estimated $242.4
adults about the severity and risk of exposure to
million annual expenditure in compensation for
excessive noise(5). Another cross-sectional study,
work-related hearing loss in the United States(2).
that involved 83 workers, showed a negative
NIHL may be inflicted by short bursts of
attitude of workers towards NIHL preventive
loud sound or continuously elevated noise levels.
measures(6).
Such exposures lead to cochlear hair cell
The purpose of this study was to investigate
damage, damage to surrounding supporting cells,
the knowledge, behaviors, and attitudes of adult
and ultimately degeneration of associated
population in Albaha Region of the Kingdom of
auditory nerve fibers. The level of inner ear
Saudi Arabia concerning the factors that
damage and associated hearing loss are
contribute to NIHL and the use of hearing
correlated to the intensity and duration of noise
protection.
exposure(4).

824
Received: 2/12/2017 DOI: 10.12816/0043989
Accepted: 12/12/2017

Full Paper (vol.705 paper# 19)


c:\work\Jor\vol705_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 828-834

Gastroesophageal Reflux Disease among Pilgrims during the Hajj Period
(1438 Hegira): Prevalence and Impact on the Quality of Life
Sultan Salem Murayziq Algethami1, Hamad Sulayyih Hamad Alosaimi1,
Meshari AhmadAali Al-Malki1, Abdullah Matar almalki1, Mohammed Thamer Shaker Alghalibi1,
Turki Fehaid Musayfir Algethami2, Abdulaziz Turki Hassan Almalki1, Turki Hamed Alghamdi1,
Afnan Salem Murayziq Algethami1, Dalia Dakheel Allah Algthami1, Asayil Nasser Bin Madhi3
1Faculty of Medicine, Taif University, Taif, 2Faculty of Medicine, Taibah University, Al-Madinah, 3Faculty of
Pharmacy, Taif University, Taif, KSA
ABSTRACT
Background: Gastroesophageal reflux disease (GERD) is a chronic motility disorder resulting in reflux of
stomach contents in to the esophagus. It has a prevalence rate of 10-20% in the western world. In the Gulf
region, the prevalence of GERD is not yet well characterized. Annually, millions of Muslims gather from across
the world embark on a religious pilgrimage to Mecca in Saudi Arabia. They represent a population with various
socio-demographic characteristics, life styles, dietary habits and social life stresses that might affect the
prevalence of this chronic disorder. Objective: the aim of this study was to determine the prevalence and impact
of GERD on the pilgrims in Mecca region during the Hajj period in the year 1438 Hegira.
Methods: participants were asked to fill a self-administered questionnaire, GERD questionnaire (GERDQ) and
GERD-HRQL were used for making the diagnosis of GERD and to assess its impact on the patient's quality of
life. Results: the prevalence of GERD among the study population was 29.0%, with a statistically significant
association with age and nationality. Neither smoking nor the presence of other diseases showed statistically
significant relationship with the presence of GERD (p>0.05). GERD-HRQL scale showed a statistically higher
median in GERD patients compared to healthy subjects. Moreover, 58 participants (52.73%) showed poor
quality of life compared to 52 participants (47.27%) who expressed good quality.
Conclusion: this study showed a prevalence rate of GERD among pilgrims in Mecca region to be 29.0%, which
has an impact on their daily life activities. These data indicate a need for a comprehensive approach to GERD
management in the health-care system.
Keywords: gastroesophageal reflux disease, pilgrims, Saudi Arabia, prevalence, quality of life.

INTRODUCTION

The burden of the disease is large; it can
Gastroesophageal reflux disease (GERD) is
influence the patient's health-related quality of life
a chronic motility disorder resulting in reflux of
and affect dietary habits, productivity, and
stomach contents into the esophagus(1).GERD is one
employment status(6,7).A few studies have been done
of the most common gastrointestinal disorders in
in Saudi Arabia on general population and have
adults. It has a prevalence rate of 10-20% in the
reported a very high prevalence(8). Annually,
western world, whereas Asian countries have a
millions of Muslims gather from across the
lower rate of less than 5%.In the Gulf region, the
world embark on a religious pilgrimage called the
prevalence of GERD is not yet well characterized(2).
"Hajj" to Mecca in Saudi Arabia(9). They represent a
GERD represents a wide spectrum of GIT
population
with
various
socio-demographic
symptoms like heartburn, discomfort in the upper
characteristics, life styles, dietary habits and social
abdomen or acid regurgitation, which are essential
life stresses that might affect the prevalence of this
for its diagnosis. In some patients, it leads to serious
chronic disorder. So the aim of this study was to
complications, such as esophageal stricture,
determine the prevalence and impact of GERD on
gastrointestinal bleeding, or Barrett's esophagus(3). In
the Pilgrims in Mecca region during the Hajj period
addition to these more classic manifestations, GERD
in the year 1438 Hegira.
is increasingly associated with extra-esophageal

symptoms, including chronic cough, asthma,
METHODS
laryngitis, and dental erosions(4).
Ethical considerations
There are many factors that can contribute to
Ethical approval was obtained from the
the development of this disease, including age,
Institutional Review Board of The Faculty of
obesity, lifestyle factors such as smoking, physical
Medicine, Taif University. The study participants
activity and/or nutrition. Additionally, genetic
were not asked for their personal information.
factors may play an adjuvantrole(1,5).
Subjects willingly participated in the study and an
828
Received: 3/12/2017 DOI: 10.12816/0043990
Accepted: 13/12/2017

Full Paper (vol.705 paper# 20)


c:\work\Jor\vol705_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 835-844



Awareness and Knowledge of Poor Vision among Students in Hail University
Manal Zayed Alshammary, Fatimah Saud Alshammari, Hadeah Salem Alsahammari,
Tahany Faisal Alshammari, Abdullah Saud Alshammari and Mona Shaheen
Faculty of Medicine, Hail University, Hail, KSA
ABSTRACT
Background:
Awareness of common eye diseases particularly impaired vision and their prevention and treatment
can play an important role in encouraging people to seek timely eye care and can therefore help in reducing the
burden of visual impairment.
Objective: This cross sectional observational study was carried out to assess the level of awareness and
knowledge about the problem of poor vision among Saudi students in Hail University.
Methods: A standardized questionnaire was randomly distributed to students aged 18-24 years of both sexes. A
total of 1484 subjects agreed to participate, answered the questionnaire and were involved in the study.
Results: Findings showed that1330 students considered poor vision to be a problem. Most of them considered
elders the most susceptible age group followed by teenagers. More than half of the students did not know which
gender is more affected by poor vision. More than one-third (37.5%) of them considered poor vision as a genetic
disorder. Others reported errors of refraction, cataract and senility (10.6%, 8.4% and 6.55%respectively).
However, 28.3% of the students did not know exactly the predisposing causes of poor vision. Two-thirds of the
study population thought that poor vision could be prevented. Regular periodic examination of the eyes and
prevention of the predisposing factors were recommended (31.3% and 32.7% respectively) as the best methods to
prevent poor vision. There was significant association between the level of awareness and knowledge of the
students about poor vision and the gender, type and level of education.
Conclusion: The detected levels of knowledge is still not the optimum especially among female students, non-
scientific colleges and in the earlier levels of university education. This emphasizes the need to involve such
students in a proper eye health education program. This will help increasing the awareness of the community at
large.
Keywords: poor vision; awareness; students; survey.

INTRODUCTION

substantial effects on their physical, mental and
Vision is the capability of seeing with an
social development. Childhood blindness remains as
unambiguous sensitivity of features, color and
a major concern and a priority disease of the global
contrast, and to differentiate between objects
initiative for the elimination of avoidable blindness
visually (1).Low vision is defined as central visual
by the year 2020: "VISION 2020 - The Right to the
acuity of 20/70 or worse in the better-seeing eye
Sight"(4).
with best correction or a total visual field loss of 140
It is essential to properly design appropriate
degrees. Legal blindness is defined as central visual
and relevant measures to address the problem of
acuity of 20/200 or worse in the better-seeing eye
vision impairment and blindness. In a community-
with best correction or a visual field of 20 degrees or
based outreach program different preventive
less (2).
measures could be introduced and emphasized to
Globally, millions of people of all ages have
address various causes of poor vision, especially
moderate or severe vision impairment. Cataract and
those related to nutritional problems, infection and
uncorrected refractive error, which are completely
injury. Close collaboration of all stakeholders such
treatable causes, are responsible for the majority of
as family physicians, parents, community support
cases of blindness. Less frequent causes of blindness
groups, etc., could further enhance a better eye care
and vision impairment include glaucoma, age-related
screening and treatment of diseases(5).
macular degeneration, corneal opacity, diabetic
Awareness of common eye diseases and
retinopathy and trachoma.Some of these diseases are
their prevention and treatment can play an important
preventable and treatable as well(3).
role in encouraging people to seek timely eye
Although the problem is relatively common
care,hence, reducing the burden of visual
in older people, causes of childhood blindness and
impairment. Well informed students are likely to
visual impairment are not uncommon, and they have
increase the awareness and knowledge of others
835
Received: 3/12/2017 DOI: 10.12816/0043991
Accepted: 13/12/2017

Full Paper (vol.705 paper# 21)


c:\work\Jor\vol705_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 845-849
How Intern Doctors deal with Hepatitis B in Riyadh and Eastern Saudi Arabia
Saad K Boqursain1, Hawraa R Alsuroj 1, Musaab I Alhawas 2, Abeer A Alkhalaf 3, Hussain S
Almazyadi 4, Muhannad M Aldubaykhi 5, Amjaad S Aljelban 6, Shahad T Aldawsari 7, Mouhab R
Jamalaldeen7, Mohammed H Alshehri 7, Maitham S Alzaer 4, Matra M Fagihi8,
Mohammed S Alharthi8, Fahad F. Almutairi9, Sajjad M Almusawi 4, Mohammed H Almahdi10.
1King Faisal University, 2 Maternity And Children Hospital, 3Princess Noura University, 4Wroclaw Medical
University, 5Qassim University, 6King Khalid University, 7King Saud University, 8Prince Mansour Military
Hospital, 9Almaarefa College, 10King Fahad Hospital In Hofuf.
ABSTRACT
Background:
Hepatitis B is one of popular health problem and is considered as major global infectious hazard.
It represents an occupational risk for all people who are working in healthcare, including doctors, nurses,
laboratory staff, and training interns as well as the student who is trained in hospitals. This can be correlated with
their contact with body fluids during clinical rotations and activities. However, protection from getting any
infection logically is mandatory for healthcare worker. Aim: Our problem in this study was to assess how our
new doctors in Saudi Arabia, specifically those in Riyadh Region and Eastern Region are safe and are protected
from hepatitis B infection by evaluating their knowledge, attitude and practice towards Hepatitis B.
Method: That was a cross-sectional study which was conducted to intern doctors in Riyadh and Eastern Regions.
Random sampling technique was used to select 350 intern doctors. Study tool was a self-administrated
questionnaire that is made online by using Google drive forms and sent as an internet link to all interns via
WhatsApp mobile application. Data analysis was done using computer application SPSS 24. Comparison
between results and many variables was done using Chi-Square test and statistical significance is considered
when P-Value < 0.05. Result: In this study, 131 intern doctors participated out of 350 who received the
questionnaires (response rate 94.6%). Regarding the level of knowledge, attitude, and practice, around 86% of
participants have good knowledge, 63% of them have a positive attitude and 85% have a good practice. Chi-
Square test was applied to compare our results of KAP with gender and region. No difference between males and
females was found in the level of knowledge and attitude (P-value > 0.05). Males were better than females in
practice (P < 0.05). Intern doctors in Riyadh region were better than those in Eastern region in knowledge and
attitude (P-value < 0.05), no difference was found between them in practice (P-value > 0.05). Conclusion: It was
obvious that our new doctors in Eastern and Riyadh regions have good knowledge, attitude and practice for
Hepatitis B. People in Eastern region have less knowledge and attitude compared to those in Riyadh with a
significant difference between them. Also, males interns have a better practice than females interns in general.
Keywords: Hepatitis B, Saudi Arabia, Intern Doctors, Riyadh region, Eastern region.

INTRODUCTION
immunization program that was started at 1990
Viral hepatitis is an inflammation of the liver
included health care workers as well as other people
that leads to chronic liver disease, liver cirrhosis, and
at risk of getting hepatitis such as children in school
hepatocellular carcinoma and finally, may cause
[5]. So, this is considered a good indicator of the
fulminant hepatitis. Hepatitis B is one of the most
efforts done by the Saudi government to protect
common viral hepatitis in addition to hepatitis C [1].
healthcare workers from getting infected with their
Hepatitis B is one of the popular health problems
clinical exposure. Epidemiologically, in 2007
and is considered as a major global infectious
ministry of health in Saudi Arabia considered
hazard. It also represents the occupational risk for all
hepatitis as second most common viral infection
people who are working in healthcare, including
(after chickenpox) by average nine thousand new
doctors, nurses, laboratory staff, and training interns
diagnosed cases in that year. In which there was
as well as the student who is trained in hospitals, due
52% of them was hepatitis B [6]. However, protection
to their contact with body fluids during clinical
from getting any infection logically is mandatory for
rotations and activities [2].
healthcare worker. Our objective in this study was to
Hepatitis B is highly prevalent all over the
assess how we keep our new doctors in Saudi
world, in which average of two billion people
Arabia, specifically those in Riyadh Region and
infected and around 240 million developed chronic
Eastern Region safe and protected from hepatitis B
hepatitis B infection, with a mortality rate of one
infection by evaluating their knowledge, attitude and
million every year [3]. However, Hepatitis B is highly
practice towards Hepatitis B.
prevalent among healthcare workers and it is two to
METHODOLOGY
ten times more than others [4]. In Saudi Arabia, the
In this study, our aim was to focus on Kingdom of
story of hepatitis B, in general, is better due to
Saudi Arabia, specifically Riyadh and Eastern
Hepatitis B vaccination that was started in 1989 and
845
Received: 4/12/2017 DOI: 10.12816/0043992
Accepted: 14/12/2017

Full Paper (vol.705 paper# 22)


c:\work\Jor\vol705_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 850-854

Awareness of Osteoporosis among Saudi Population in
Saudi Arabia Especially Taif governorate

Abdulaziz Saleh Alharthi
Taif University
ABSTRACT
Background:
Osteoporosis is a worldwide health problem leading to an increased susceptibility to fractures and
even more other complications. Awareness and perceptions of susceptibility and belief in the seriousness of a
disease can help in its prevention and control.
Objective:
this study was aimed to evaluate knowledge and perceptions of osteoporosis among Saudi
population from different country regions and different educational levels.
Methodology: 986 participants from all over Saudi Arabia regions and the majority of them were from Taif
governorate they were involved in a self- administered online questionnaire that was conducted in August, 2017
through the period to November, 2017 and was available online and easy to access to wide group of people, to
evaluate the extent of knowledge about osteoporosis among Saudi population from those different regions of the
country. Results: 986 participants from all over Saudi Arabia regions and the majority of them were from Taif
governorate they were involved in a self- administered online questionnaire to evaluate the extent of knowledge
about osteoporosis among Saudi population from those different regions of the country.The majority of the
participants were aware of some knowledge about osteoporosis but female respondents were more
knowledgeable in some very important points in this manner. Age was negatively correlated with the level of
awareness though Awareness of osteoporosis was significantly different between educational groups.
Conclusion: It is important to raise the awareness and knowledge of osteoporosis and its prevention measures
as osteoporosis is a preventable disease among Saudi population. Saudi Ministry of health need to determine the
population's knowledge of and attitudes towards osteoporosis to plan effective education programs to be able to
avoid late complications and to safe highly cost methods of treating such a conditions.
Keywords: Osteoporosis, Awareness, prevention, perceptions, Saudi, Arabia, Taif

INTRODUCTION

Osteoporosis is a major and growing public
METHODS
health problem in both sexes especially in
Setting
postmenopausal
women.
Osteoporosis
is
A cross sectional study was conducted among
characterized by decreased bone mass and micro-
Saudi population in Saudi Arabia especially Taif
architectural deterioration of bone tissue leading to
governorate. The population of Saudi Arabia varies
an increased susceptibility to fractures. In addition, it
from one region to another and that why this study
is the most common metabolic disease that increases
conducted using online survey to give the possibility
mortality and morbidity among elderly people(1). It is
to those different regions population to participate in
a silent illness so can be unrecognized for a long
this questionnaire, and this one of the strength factor
time until a fracture occurs(2). There are many risk
of our study. The kingdom is situated in Southwest
factors for osteoporosis however; the most important
of Asia and it has 13 administrative provinces
are genetics, smoking and alcohol abuse, poor
including Al-Riyadh, Taif, Mekkah, Madinah,
nutrient intake, deficiency of calcium and vitamin D,
Eastern Province, Ha'il, Jauf, Tabuk, Najran, Bahah,
and decrease in sex hormone production(3). Since
Northern Borders, Jizan and Asir. According to the
there is no cure of osteoporosis corrective action
central department of statistics and information of
must be taken to slow down and for protecting of
Saudi Arabia the population is 30,770,375.
osteoporosis(4). Because osteoporosis can affect any

age during life, it is highly crucial to acquire
Study Design, Subjects and Intervention:
maximum peak bone mass during early life(5) as the
The study was a cross sectional exploratory
amount of bone mass achieved during that age
one, 986 participants from all over Saudi Arabia
determines the quality of bones in later life.
regions and the majority of them were from Taif
According to WHO, There is approximately 75
governorate. They were involved in a self-
million people in Europe and America are
administered online questionnaire to evaluate the
complaining of osteoporosis and 9 million fractures
extent of knowledge about osteoporosis among
worldwide are result from osteoporosis every year
Saudi population from those different regions of the
(6).
country. The survey was conducted in August, 2017
OBJECTIVES
through the period to November, 2017 and was
This study was aimed to evaluate knowledge and
available online and easy to access to wide group of
perceptions of osteoporosis among Saudi population
people. The research had been ethically approved by
from different country regions and different
Taif Research Ethics Committee. The questionnaire
educational levels.
used in the study is the self-reported OKAT
850
Received: 5/12/2017 DOI: 10.12816/0043993
Accepted: 15/12/2017

Full Paper (vol.705 paper# 23)


c:\work\Jor\vol705_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 855-858
Sonographic Dimensions of Normal Kidney Among Children
Anas Sulaiman Aloraini1, Ali Mekbel Aldahmashi2
1College of Medicine, King Saud University, 2College of Medicine,
Umm Al-Qura University, Saudi Arabia

ABSTRACT
Background:
the measurement techniques vary between operators, and there is a lack in standards for
measuring either renal length or volume. Individual observation shows that optimal sonographic
technique varies with sonography system and transducer combination.
Objectives: the purpose of this review was to combine the sonographic measurements and morphology of
normal kidney among children obtained.
Materials and Methods: An electronic search was conducted in CINAHL, EMBASE, and MEDLINE
databases. The search resulted in 42 relevant studies, from which 8 studies were met the inclusion criteria.
The information was extracted from these studies.
Results: in the included studies, the length of right kidney ranged from 4 cm to 7.9 cm. Three studies
from the all eight studies of this review revealed that the mean length of the right kidney was 7.6 cm, the
rest five studies was with length ranged between 4.2 cm to 6.8 cm and the length of left kidney ranged
between 4 cm to 8.4 cm. There are two studies found that length was equal both in right and left kidneys.
Conclusion: Assessment of kidney size using sonography can be an early screening technique for these
conditions especially among children.
Keywords: Sonography; Kidney; Dimensions; Children; Hypertrophy.

INTRODUCTION

assessment of renal size in children, because of
Kidney size is an essential parameter for
safety and simplicity in evaluation of renal length
evaluating pediatric renal and genitourinary tract
and volume (5). It is non-invasive imaging
pathologies (1). Measurement of kidney size is
modality and have widespread applications in
important because many current disorders with
pediatric urology (1).
enlargement or kidney reduction, which means
Proper body developments and functions are
that renal size and function determined the health
directly related to organ growth rate. The growth
status of the kidney (2). It can be helpful and
rate of renal length will be evaluated in
facilitate the follow up for the treatment of
association with distinct measurements like
children with chronic pyelonephritis, obstructive
weight, height and anthropometric parameters
uropathy, and chronic glomerulonephritis in early
such as body mass index (5). Measurement
childhood. Sonography helps in accessing and
techniques vary between operators, and there is a
following the patients of urolithiasis, cystic
lack in standards for measuring either renal
kidney
diseases,
malignancies,
infections,
length or volume. Individual observation shows
vesicoureteric reflux and renal transplant in
that optimal sonographic technique varies with
elders as well as in children (3).
the used sonography system and transducer
Serial volume measurements can be used to track
combination(6). The purpose of this review was to
the normal growth pattern of kidneys and to
combine the sonographic measurements and
follow the known pathology of kidney in
morphology of normal kidney among children
children. The establishment of normal kidney
obtained by different studies from different
values in routine imaging tests can serve as a
population.
baseline for the diagnosis of kidney disease

associated with changes in size, such as acute or
METHODS
chronic pyelonephritis (4). There are several
An electronic search was conducted in
methods for measuring renal sizes, including
CINAHL, EMBASE, and MEDLINE databases
abdominal CT and MRI. However, these
using
search
strategy
(Sonography
OR
approaches have disadvantages such as radiation
Ultrasound OR US) AND (Kidney OR Renal)
exposures and high costs. Also, due to the need
AND (Size OR Morphology) AND (Children OR
for sedation in CT or MRI, and the radiation
Infants OR Newborns). The search resulted in 42
exposure associated with CT, we prefer US
relevant studies, from which 8 studies were met
evaluation in pediatric patients (5). In comparison,
the inclusion criteria. The information was
sonography is the preferred method for
extracted from these studies in the table 1. The
855
Received: 5/12/2017 DOI: 10.12816/0043994
Accepted: 15/12/2017

Full Paper (vol.705 paper# 24)


c:\work\Jor\vol705_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 859-865

Effect of Obesity in The Outcomes of Patients Admitted to Intensive Care Unit
Khalid Nasser Mohamed Sinnah
Medicine College, King Khalid University, Saudi Arabia
Corresponding author: Khalid Nasser Mohamed Sinnah, E-Mail: dr.expert333@gmail.com

ABSTRACT
Background:
The physiological changes associated with obesity may impair the ability to withstand the
stress of critical illness, and particularly in surgical postoperative patients, the effects on cardiovascular and
respiratory systems may translate into prolonged time on a ventilator or intensive care unit survival.
Objectives: This review aiming at evaluation of the effect of obesity in patients admitted to intensive care
unit.
Materials and Methods: An electronic search was conducted in Medline using this built search strategy. The
search was limited to the human studies conducted in the last 10 years. The search resulted in 368 articles and
after exclusion of irrelevant, duplicated, and review articles only 26 articles were included in this review. The
information about general characteristics and outcomes of these studies were collected using data sheets.
Results: The predominance of weight has been consistently expanding around the world, and obesity itself is
viewed as an interminable illness and additionally a noteworthy general medical issue. However, not very
many information is accessible on the relationship amongst BMI and basic care result. Additionally, examine
is expected to recognize vital associates of basic care in relationship to BMI with the goal that this data can be
utilized to nurture patients and enhance results.
Conclusion: BMI demonstrated no noteworthy effect on bleakness or mortality in basically sick patients.
Mortality in basic care was related with seriousness of sickness at affirmation and ICU-related intricacies.
Keywords: Obesity; BMI; Intensive Care; Mortality; Survival.

INTRODUCTION

Obesity is a growing health care problem. The
been reported in obese patients with specific
recent increase in the percentage of obese people
diagnoses, including acute heart failure, chronic
in the Western world is paralleled by the rise in
kidney disease, and HIV/AIDS(5). This review
the number of obese patients requiring care in the
aiming at evaluation of the effect of obesity in
intensive care unit (ICU) (1). The physiological
patients admitted to intensive care unit.
changes associated with obesity may impair the

ability to withstand the stress of critical illness,
METHODS
and particularly in surgical postoperative patients,
An electronic search was conducted in
the effects on cardiovascular and respiratory
Medline
using
this
search
strategy
systems may translate into prolonged time on a
(obesity[Title/Abstract])
AND
(intensive
ventilator or ICU survival(2).
care[Title/Abstract]
OR
critical
The relationship between obesity and a
care[Title/Abstract] OR ICU[Title/Abstract] OR
patient's outcome in the ICU has been looked at
emergency
department[Title/Abstract]
OR
by many researchers, particularly in medical
ED[Title/Abstract])) AND (death[Title/Abstract]
patients, and many conclusions have been reached.
OR
mortality[Title/Abstract]
OR
Some studies found obesity related to increased
cure[Title/Abstract]
OR
mortality and morbidity, whereas others showed
discharge[Title/Abstract]).
either no association or even decreased mortality

and morbidity(3).
The search was limited to the human studies
Basically, sick patients who were overweight
conducted in the last 10 years. The search resulted
had uniquely brought down 30-day and 1-year
in 368 articles and after exclusion of irrelevant,
mortality chance in spite of having higher rates of
duplicated, and review articles only 26 articles
numerous
comorbidities
and
comparative
were included in this review. The information
affirmation keenness contrasted and their ordinary
about general characteristics and outcomes of
weight partners(4). After one year of acute
these studies were collected using data sheets.
morbidity, even very obese patients had a critical

survival advantage. The defensive impact of
The study was done after approval of
weight (termed the "obesity paradox") has also
ethical board of King Khalid university.


859
Received: 6/12/2017 DOI: 10.12816/0043995
Accepted: 16/12/2017

Full Paper (vol.705 paper# 25)


c:\work\Jor\vol705_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 866-868

The Use of Preoperative Magnetic Resonance Imaging in the
Screening and Diagnosis of Breast Cancer
Ali Mekbel Aldahmashi1 Anas Sulaiman Aloraini2
1College of Medicine, Umm Al-Qura University, Saudi Arabia,
1College of Medicine, King Saud University

ABSTRACT
Background:
Understanding the clinical applications for breast MRI that are supported by the scientific
evidence is important to ensure proper use of this medical resource. The use of MRI increased from 2005 to
2008 for women with both in situ carcinoma and invasive carcinoma.
Objectives: this review aiming at assessing the evidence supporting use of MRI in the screening and
diagnosis of breast cancer.
Methods: a systematic search was conducted in main databases using keywords. The relevant studies that
met inclusion criteria were included in this review. The findings of the included studies were discussed in
this narrative review. The protocol of this review was approved by technical and ethical committee.
Results: many studies found that breast MRI is advantageous when used to examine patients with high risk
for breast cancer, assessment the ipsilateral and contralateral breasts in patients with diagnosis of new breast
carcinoma, assessing patients with metastasis and unknown primary, patients monitoring with chemotherapy.
When used in these clinical scenarios, high sensitivity of MRI results in early detection of cancer or greater
accuracy of detection compared with existing clinical and imaging tests.
Conclusion: MRI is an excellent tool for determining the extent of tumor, and should be performed
especially in the dense breasts. To avoid overestimation and to diminish false positive examinations, MRI
should be performed in the second week of the menstrual cycle and after the interruption of hormonal
therapy.

INTRODUCTION
relevant studies that met inclusion criteria were
Magnetic resonance imaging (MRI) is a very
included in this review. The findings of the
important tool in the armamentarium for breast
included studies were discussed in this narrative
imaging (1). The key benefits of breast MRI are its
review. The protocol of this review was approved
high sensitivity for detection of breast carcinoma
by technical and ethical committee of Umm Al-
and the ability to depict Cancers that are vague on
Qura University.
ultrasound, mammography, and clinical breast

examination. Owing to enthusiasm for its merits,
RESULTS
there has been a rapid increase in the use of breast
Preoperative MRI evaluation of the extent of
MRI during the last decade (2). Additional gains in
disease in the ipsilateral breast in patients with a
use
are
expected
given
the
recent
recent cancer diagnosis has several potential
recommendations by American Cancer Society
benefits. Multiple studies have now demonstrated
(ACS) that breast cancer screening in some
that breast MRI is advantageous when used to
categories of women at high risk now include
examine patients with high risk for breast cancer,
annual MRI (3). MRI is a valuable tool for the
assessment the ipsilateral and contralateral breasts
detection and characterization of breast cancer and
in patients with diagnosis of new breast
for the assessment of breast implant integrity.
carcinoma, assessing patients with metastasis and
Understanding the particular clinical applications
unknown primary, patients monitoring with
for breast MRI that are supported by the scientific
chemotherapy. When used in these clinical
evidence is important to ensure proper use of this
scenarios, high sensitivity of MRI results in early
medical resource(4). The use of MRI increased
detection of cancer or greater accuracy of
from 2005 to 2008 for women with both in situ
detection compared with existing clinical and
carcinoma and invasive carcinoma(2). This review
imaging tests(4). Cancer metastasis is an ineffective
aiming at assessing the evidence supporting use of
process(5) .
MRI in the screening and diagnosis of breast
MRI is the most sensitive imaging technique
cancer.
to breast cancer detection(6). This high rate of
METHODS
breast cancer detection is based on various
The systematic search was conducted in main
physical principles other than those used in
databases using keywords (MRI OR Magnetic
ultrasound and mammography (7).
Resonance Imaging) AND (Breast Cancer). The
866
Received: 6/12/2017 DOI: 10.12816/0043996
Accepted: 16/12/2017

Full Paper (vol.705 paper# 26)


c:\work\Jor\vol705_27 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 869-871

Stress, Depression and Anxiety among Medical Students of Imam Mohammed
Ibn Saud Islamic University, KSA
Abdullah Ali Alshehri*, Fares Abdullah Alaskar*, Fahad Khalid Albahili*
* Finished internship, Imam Muhammad Bin Saud University, Riyadh, KSA
Abstract:
Background:
Exposure of Physicians to some stress factors during the occupational environmental work
could induce some psychological problems. The first postgraduate years are particularly susceptible to these
problems. In Arab countries, epidemiological data about psychological morbidity among medical
undergraduate students are scarce. The Objective of the present study was to assess anxiety and depression
levels among the third-year imam medical college students. Methods: A cross sectional study was done on
the medical students of the 3rd year at Imam University; College of Medicine in Riyadh city on 2013. The
sample consisted of 50 male medical students. The Higher Education Stress Inventory (HESI) was used in
data collection. Results: Our results showed that 24% of the students were with minimal depression, 18% of
students was with mild depression, 8% of student was with moderate depression, 2% of student was with
moderately severe depression and none (0%) of student was reported with severe depression. Conclusion:
The study indicated that medical students are extra sensitive to deal with the environmental occupational
atmosphere which stress factors could prevail, so, depression and anxiety are common among medical
students. Large, prospective, multicenter, multi-method studies are needed to identify personal and curricula
features that influence stress, depression, anxiety and coping strategies among medical students. The study
findings highlighted the need of psychiatric counseling and preventive mental health services to be an
integral part of the routine clinical facilities caring for medical students.
Keywords:
Stress, depression, anxiety, Saudi Arabia, medical student, Imam University.

INTRODUCTION

Depression and anxiety levels in the community
successful students reported somewhat higher
are considered as specific indicators for mental
levels of depressive ideation and symptomatology
status of a person. Various studies have indicated
[5]. The potential negative effects of emotional
that stress during the work regime could
distress on medical students include impairment of
negatively induce effects on medical students.
functioning in classroom performance and clinical
The
American
Psychological
Association
practice, stress-induced disorders and deteriorating
characterizes anxiety and stress [1, 2] by feelings of
performance. Students in extreme stress or
tension, worried thoughts, and physical changes.
depression need serious attention, otherwise
Anxiety is more related to autonomic arousal,
inability to cope successfully with the enormous
skeletal muscle tension, and situational aspects,
stress of education may lead to a cascade of
whereas stress is more related to irritability,
consequences at both personal and professional
impatience, and difficulty in relaxing [3]. Among
levels [6]. The subject has been studied in many
medical students, academic stressors include the
countries; however, another similar studies was
demands of the learning and training, the large
done in Ziauddin Medical University, by Inam S
volume of material to be learned and academic
et al. [7], in a study in Riyadh, Saudi Arabia by Al-
performance and evaluation (examination and
Samghan AS et al. [1] and in another study in
continuous assessment) might adversely affect the
Riyadh, Saudi Arabia by Bibi Kulsoom and Nasir
student's physical and mental health. It has been
Ali Afsar [6].
reported that medical students consequently suffer

from depression, anxiety, and stress[4]. Yusoff et
OBJECTIVE
al. have previously reported that healthy students
This study was designed to assess anxiety and
develop depression and stress after commencing
depression levels among third year imam medical
their medical education. Academically less
college students in Riyadh city on 2013.
869
Received: 7/12/2017 DOI: 10.12816/0043997
Accepted: 17/12/2017

Full Paper (vol.705 paper# 27)


c:\work\Jor\vol705_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 872-876

Prevalence of Migraine Among Medical Students in Jazan
University and Its Impact on Their Daily Activities
Ameera Akour, Wejdan Shabi, Asrar Ageeli, Kadejah Najmi, Yousif Hassan
Jazan University
Corresponding Author: Ameera Akour , email: ameeraakour@yahoo.com, mobile: 00966599838812

Background: Headache is considered as one of the most common disorders of the central nervous system ,
and there are many types of it . One of them is migraine headache. Worldwide it is a common disabling
primary headache syndrome. Medical students most of the time are exposed to its various triggers. This
might have huge impact on their lives and their academic performance. This topic has been studied in many
countries to highlight the prevalence of migraine headache and to study its impact on the students' life and
academic performance. Unfortunately, no similar study was conducted neither in Jazan Area nor in Saudi
Arabia as a whole
Objectives: The main goal of this study was to know the prevalence of migraine headache among medical
students at Jazan University and to assess its effect on their daily activities .
Methods: A cross-sectional survey was conducted during 2016-2017 academic year in Jazan university.
260 students were examined. The data were collected by using self-administered questionnaire which
included demographic data and specific questions on headache based on international Headache Society
criteria for diagnosis of migraine and other headache types. The collected data were analyzed by using
SPSS program .
Results: The results showed that the prevalence of migraine among medical students was 5.0%. There was
no significant difference between the gender according to p-value , but regarding the years of university
studying there was significant difference in which the prevalence increased in parallel with advancing
academic years at the university.
Conclusion: the prevalence of migraine among medical students was found to be less than what seen in
similar studies in different countries , without significant difference between the gender. All the students
reported that the headache was interfering with their daily activities. Fatigue, too little sleep, and bright light
were the most common triggering factors were identified in our study.
Keywords: Migraine, Daily Activities, Medical.

INTRODUCTION
headache. These include exertion and routine
A headache is an extremely common
physical activity. Being in
disorder encountered in everyday life. It affects

both men and women of all ages. There are many
quiet, dark room ameliorates migraine attack2,3.
types of headache. These include a migraine,
Medical students most of the time are exposed to
cluster, and tension-type headache to mention
its various triggers. This might have huge impact
few. Headache can lead to significant disability to
on their lives and their academic performance.
the affected individuals. Now, it is well
This topic has been studied in many countries to
recognized that headache is both underestimated
highlight the prevalence of a migraine headache
and undertreated in many societies.1 a Headache is
and to study its impact on the students' life and
classified as primary when there is no clear
academic performance4,5. Unfortunately, no
underline etiology and secondary when it is due
similar study was conducted neither in Jazan
to a known cause like brain tumor1,2. Among the
Area nor Saudi Arabia as a whole.
primary headaches, migraine is a common

disabling condition. Many studies confirmed that
OBJECTIVE OF THE STUDY
migraine has high prevalence with a huge impact
The main goal of our study was to know the
on the life of affiliated individuals. Clinically, it
migraine headache prevalence among medical
is described as a unilateral headache that
students of Jazan university and to assess its
sometimes changes side. It is characterized by
effect on their lives and medical performances.
being a throbbing headache that lasts anywhere

between 4 to 72 hours. Between attacks, the
METHODS
affected individuals are quite normal. It is noted
Study design and place
that some factors might aggravate a migraine
The study was observational descriptive cross-
sectional design. It was conducted at the college
872
Received: 7/12/2017 DOI: 10.12816/0043998
Accepted: 17/12/2017

Full Paper (vol.705 paper# 28)


c:\work\Jor\vol705_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 877-881

Bevacizumab for the Treatment of Macular Edema
Yazid Abdulrahman Alhadlg, Abdulrahman Khalaf Alkhalaf
Royal College of Surgeons in Ireland
Corresponding author: Abdulrahman Khalaf Alkhalaf, E-Mail: a.khalaf@binrushd.net

ABSTRACT
Background:
anti-vascular endothelial growth factor (anti-VEGF) has been suggested for the treatment of macular
edema. In this study we are assessing the efficacy of one type of anti-vascular endothelial growth factor which is
Bevacizumab (Avastin) in the reduction of macular thickness.
Patients and Methods: from the period of February 2012 to February 2015, we have gathered the data of 54
patients (39=males, 15 =females) suffering from macular edema who received variable number of intraocular
injections of Bevacizumab to be included in a retrospective study. One eye from each patient was chosen randomly
and then we observe their follow-up Optical Coherence Tomography (OCT) for any changes in the thickness of the
macula.
Results: after receiving a single Bevacizumab injection, 16 patients (29.6%) did not show any improvement while
22 (40.7%) patients show an improvement that was less than 50 microns of reduction in magnitude, 5 patients
(9.2%) showed an improvement that was greater than 50 microns in reduction of macular thickness and the
remaining 11 patients (20.3%) had a reduction of macular thickness that was greater than 100 microns.
Conclusion: despite being used originally for metastatic colon cancer, Bevacizumab (Avastin) can be used in the
treatment of diabetic macular edema.
Keywords: diabetic retinopathy, Bevacizumab, intravitreal injection, macular edema, vascular endothelial growth
factor.

INTRODUCTION

One of the most common disorders that the
leakage of plasma constituents into the surrounding
contemporary world population is suffering from is
retina and, consequently, retinal edema" (4). Macular
diabetes mellitus, with an estimated global prevalence
edema is classified into 2 main categories: cystoid and
of 9% among adults aged 18+ years (1). Diabetes can be
diabetic macular edema (4).
defined as a heterogeneous and complex disorder of the
The normal thickness of the macula is
body metabolism characterized by high levels of
defined by two variables: foveal thickness and central
glucose concentration in the blood (2). Diabetes has a
foveal thickness, the normal foveal thickness in
major impact on the body normal physiology and one of
healthy eyes when measured by Optical Coherence
its complications is its effect on the body vasculature,
Tomography (OCT) is 21220 m and the central
especially the eye, where it causes the clinical condition
foveal thickness is 18223 m (5). Patients with
of "diabetic retinopathy". Diabetic retinopathy has 4
macular edema suffer from blurry or wavy central
main stages: mild, moderate and severe Non-
vision, and their color perception may be disrupted (6).
Proliferative Diabetic Retinopathy (NPDR) followed by
The treatment of macular edema varies between
Proliferative Diabetic Retinopathy (PDR), and macular
different doctors. Three main treatment options were
edema can develop in any of these stages (3).
considered in the past (7):
Macular edema can be defined as: "retinal 1- Focal laser treatment,
thickening within 2 disc diameters of the center of the 2- Non-steroidal anti-inflammatory drugs (NSAIDs) and
macula, results from retinal microvascular changes
Intravitreal implants.
that compromise the blood-retinal barrier, causing
877
Received: 8/12/2017 DOI: 10.12816/0043999
Accepted: 18/12/2017

Full Paper (vol.705 paper# 29)


c:\work\Jor\vol705_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 882-890
Bacterial Infections and Biofilm Formation Associated with Intra Uterine
Contraceptive Device among Females Attending
Al- Glaa Teaching Hospital in Cairo
Aml El-sayedAbdou *, EmanAbd El Azeem Mohamad*,
Amany Mohamad Tawfiek*, Reda El-belbasy**
Microbiology* and Community Medicine**Departments, Faculty of Medicine
(For Girls)- Al-Azhar University, Cairo, Egypt
Corresponding author: Ass.pro.Dr. Reda M. El-belbasy,E-mail : debelbasy @yahoo.com.


ABSTRACT
Background:
Intrauterine device (IUD) is a convenient, effective and one of a long term contraceptive
procedures. However, it may act as a reservoir of reproductive tract infections.
Aim of the study:
to isolate the microorganisms in the cervix and on the removed IUDs after different times in
situ ,examine their association with microbial biofilm formation on the removed intrauterine devices, and also to
detect some common sexually transmitted bacteria.
Subjects and Methods: a total of 40 women selected randomly from the Gynecological outpatient clinic of Al-
Glaa Teaching Hospital in Cairo were included. Cervical swabs and the removed IUDs were bacteriologically
examined. The removed IUDs were analyzed by electron microscope to identify the presence of a microbial
biofilm. Real time polymerase chain reaction (PCR) was performed to detect some common sexually transmitted
infections (STIs) organisms.
Results: The mean age of the studied women was 32.126.7 years and the mean duration of IUDs in situ was
2.550.87 years . Mixed organisms (E. coli, Enterococcus faecalis, Candida , Staph aureus and others) were
detected with no significant differences between the isolated organisms from the removed IUDs (116 ) and that
from cervical swabs (134 ) ; neither nor to the duration of IUDs in situ (p>0.05). Chlamydiae
trachomatis(55%,70%),Neisseria gonorrheae(30% ,30%) and
Mycoplasma (7.5%,0.0%), were detected STIs
organisms by PCR from IUDs and swabs respectively with no statistical significant differences (p> 0.05). Thick
biofilm of multiple microorganisms was detected on the surfaces of the removed IUDS.
Conclusion:The insignificant association between microorganisms that were isolated from the cervix, removed
IUDs and biofilms may indicate the pre-existence of those organisms before and spread by IUDs insertion . IUD
may act as a reservoir for resistant microorganisms. The presence of some asymptomatic sexually transmitted
infections (STIs), may point to ,that women may act as STIs transmitters. Prior to and throughout IUDs use,
appropriate management of reproductive tract infections is vital. IUDs related prospective studies are also
recommended.
Keywords: IUDS, cervix infection, PCR , biofilm, microbiological examinations.

INTRODUCTION

transmitted infections (STIs)(4). Worldwide, more
Contraceptive methods are used to regulate
than 1 million sexually transmitted infections are
inter pregnancy spacing, avoid unwanted pregnancy
acquired with a great suffering of both men and
and prevent sexually transmitted infections (1). The
women and profound impact on sexual and
intrauterine devices (IUDs) are highly effective, long-
reproductive health (5).
term methods of contraception that have the benefit of
On the other hand, IUDs like other implanted
being reversible. In developing countries IUDs are the
devices such as catheters and prosthetic cardiac valves
most preferred means of contraception (2). In 2015,
were found to attract pathogenic bacteria and fungi
fourteen per cent of women worldwide used the
and could form a biofilm on their inert surface. A
IUD(3). However,
biofilm is a complex surface-associated cells enclosed
the presence of an IUD in the uterus may be associated
in a matrix and represent a common mode of microbial
with infertility, ectopic pregnancy and increased risk
growth. Co-infection with other pathogens will affect
of pelvic inflammatory disease (PID) and increase host
its formation. Microbial biofilm is build up when
susceptibility to infections, including sexually
micro-organisms irreversibly adhere to a surface and
882
Received: 25/9/2017 DOI: 10.12816/0044000
Accepted: 05/10/2017

Full Paper (vol.705 paper# 30)