c:\work\Jor\vol706_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 891-897

Diagnostic Imaging for Blunt Abdominal Trauma
Suraka Jaffar Rummani1, Hamed Ghazi Muslih Alhusayni2, Rha Tariq Ismail3, Abdulhalim Bakr
Hafizallah4, Mohammed Ali Al-Taweel5, Fawaz Ahmed Almehmadi6, Israa Khalid Bajabir7, TalalMislat
Alotaibi8, Nojood Sami Basodan9, AbaadAyed AL Mutairi10, Abdulaziz Khalid Alsayegh11, Ahmed
Mohammed Alzahrani12, Mohammed Mousa Alghamdi12, Ali Abdulaziz Alshamrani12
1 Ibn Sina National College, 2 Primary Health Care, Shehar Center, 3 Misr University for Sience And
Technology, 4 Taibah University, 5 King Faisal University, 6 King Abdulaziz University, 7 Umm Alqura
University, 8 Majmaah University, 9 King Faisal Hospital, 10 King Abdulaziz University Hospital,
11 University of Hail, 12 Almaarefa Colleges
Corresponding Author: SurakaJaffarRummani - Dr.suka37@gmail.com - 00966565612355

Blunt abdominal trauma is a common cause of morbidity and mortality among patients
encountering traumatic injuries, especially motor vehicle accidents, which are the leading cause of injury
worldwide. Focused abdominal sonogram for trauma, computed tomography with or without contrast, and
laparotomy are the most common ways of diagnosis and treatment. With advancement of diagnostic medicine,
the physicians are making use of non-operative methods to achieve quick results quicker and with fewer
complications. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed,
and EMBASE, January 2001, through February 2017. The following search terms were used: blunt abdominal
injury, FAST scan, US in abdominal trauma, CT for abdominal trauma, trauma management
Aim: In this review, we aimed at evaluating the various methods of diagnosis using imaging for blunt abdominal
Conclusion: The growing tendency of non-operative management necessitates early identification of the injury
sites, which is aided by the increasing sophistication of the CT techniques. Additionally, CT also provides a very
significant method for following up the patients and for detecting complications which were not diagnosed
Keywords: imaging in abdominal trauma, non-invasive diagnosis of blunt abdominal trauma, FAST scan, CT
scan for abdominal trauma

that the liver and spleen are the most repeatedly
Blunt abdominal trauma is a frequent cause of
injured organs. Further potentially injured organs
morbidity and mortality amid patients admitted after
consist of the kidneys, pancreas, bowel and
sustaining various traumatic injuries. Many patients
mesentery, adrenals, intra-abdominal vessels, and
present with multisystem injuries as a consequence
diaphragm[2]. Previously, diagnostic peritoneal
of high velocity mechanisms. Furthermore, the
lavage was used commonly to confirm the presence
existence of associated injuries may cover overt
of hemoperitoneum before laparotomy; this practice
clinical manifestations or distract the attention of the
admitting staff away from possibly life-threatening
ultrasonography, particularly, focused abdominal
intra-abdominal bleeding[1].
sonogram for trauma (FAST), completed at the
Mechanisms of blunt trauma that lead to major
bedside by a knowledgeable ultrasonographer, is
more commonly used for this purpose. FAST
compression and deceleration forces. Motor vehicle
evaluation involves visualization of the pericardium
accidents are the leading cause of injury, throughout
using a subxiphoid view, the hepatorenal (i.e.,
the world. Even though the possibility of injuring an
Morrison's pouch) and the splenorenal spaces, right
individual organ rests upon the specific mechanism
and left paracolic gutters, and lastly, the pouch of
of trauma and the susceptibility of the patient at the
Douglas. Several studies have revealed the benefit of
time of the incident. All published series established
a FAST study in the emergency decision-making
Received: 9/12/2017 DOI: 10.12816/0044323
Accepted: 19/12/2017

Full Paper (vol.706 paper# 1)

c:\work\Jor\vol706_2 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 898-901

Adult Immunization
Abdullah Bin ibrahim Saeed1, Mayada salem Alwafi2 , Amro Sultan Bokhari3,
Abrar Mubarak Algharbi4, Fahad Mohammed Al khashlan5, Anas Said Badghaish6
1 King Said Bin Abdulaziz University for Health Sciences, 2 Umm Alqura University,
3 Ibn Sina National College, 4 Almaarefa Colleges For Science And Technology,, 5 Bariq Primary Health Care
Clinic, 6 Imam Abdurhaman bin Faisal university
Corresponding Author: Abdullah Bin ibrahim Saeed - rt.attwag@gmail.com - 0561111226

Immunization recommendations depend on epidemiological factors as well as age, sex, history
of previous vaccination, current health status, occupation and lifestyle. Several vaccines are recommended for
adults including, tetanus-diphtheria-acellular pertussis, tetanus-diphtheria, influenza, human papillomavirus,
varicella, measles, mumps, and rubella, and pneumococcal 13-valent conjugate or pneumococcal 23-valent
polysaccharide, and hepatitis. Such diseases have shown dramatic decrease in incidence and mortality after
introduction of vaccines.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 2001, through February 2017. The following search terms were used: adult immunization,
adult vaccine, recent vaccine guidelines, preventive medicine, human papillomavirus, MMR, S. pneumoniae,
PCV13, PPSV23, hepatitis A, hepatitis B
Aim: In this review, we aimed at reviewing the updates in adult vaccine and their effectivity.
Conclusion: Vaccination for adult population has proved to be of extreme importance and has achieved great
successes. Combined efforts of patients, physicians, and policy makers are needed to achieve higher levels of
success and improve vaccine coverage.
Keywords: adult vaccine, tetanus-diphtheria-acellular pertussis, human papillomavirus, MMR, S. pneumoniae,
PCV13, PPSV23, hepatitis A, hepatitis B


We conducted this review using a comprehensive
Vaccine-preventable diseases have dramatically
search of MEDLINE, PubMed, and EMBASE,
decreased in both incidence and mortality since the
January 2001, through February 2017. The
introduction of vaccination. More than one hundred
following search terms were used: adult
cases of communicable diseases such as rubella,
immunization, adult vaccine, recent vaccine
mumps, diphtheria, pertussis, smallpox and many
others have been avoided since the 1900s. The last
papillomavirus, MMR, S. pneumoniae, PCV13,
three decades had more than 92% and 99% decrease
PPSV23, hepatitis A, hepatitis B
in incidence and mortality, respectively. Thanks to
· Data Extraction
vaccinations, polio, smallpox, and rubella (which
Two reviewers have independently reviewed the
were endemic in the United States) have been
studies, abstracted data, and disagreements were
eradicated. Thus, vaccines are considered among the
resolved by consensus. Studies were evaluated for
most important interventions in the history of
quality and a review protocol was followed
medicine and public health, and Center of Disease
Control (CDC) has considered vaccination
The study was done after approval of ethical
development as one of its priorities during the last
board of King Abdulaziz university.
century. Crucial benefits to both health and

economic sectors can be achieved by preventing
infectious diseases, which makes public health
strategies consider proper vaccination as an
important cost-effective target[1].
vaccination protocols for adult and elderly is always

required. These developments should include several
areas including: updating indications for adults in
· Data Sources and Search terms
different populations, associating these indications
Received: 25/10/2017 DOI: 10.12816/0044324
Accepted: 05/11/2017

Full Paper (vol.706 paper# 2)

c:\work\Jor\vol706_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 902-905

Anticoagulants: Their Adverse Effects and Reversal
Haneen Jameel Alshareef1, Omar Faisal Aloufi2, Naif Jezaa Aljohani2, Ola Abdulkarim Mirdad3,
Bushra Ahmed Alghamdi3, Hussain Ali Alqattan4
1 Umm Alqura University , 2 King Abdulaziz University, 3 Ibn Sina National College,
4 King Faisal University
Corresponding Author:Haneen Jameel Alshareef- Haneen.Albarakati@Gmail.Com - 0552922662

A balance between the coagulation systems is achieved by complicated pathways that
involve platelets, the vascular endothelium, the coagulation cascade, and the fibrinolytic system. In case
of conditions that predispose to higher coagulability, anticoagulants are used to prevent adverse
outcomes. However, strict monitoring is required to maintain the balance of thrombogeneis and prevent
dangerous complications such as bleeding.
we conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE from January 1987 to March 2017. The following search terms were used: anticoagulant,
heparin, warfarin, unfractionated heparin, factor Xa inhibitor
Aim of the work: In this study we aimed at understanding the different types of anticoagulants used and
also focus on the adverse effects and their reversal.
Conclusion: Acute bleeding remains the most important concern when using anticoagulants and its risk is
present with all agents. Although this bleeding is rarely fatal, its recognition and proper treatment is
crucial and significantly affects outcomes.
Keywords: anticoagulant, warfarin, heparin, unfractionated heparin, factor Xa inhibitor

(NACs) have been developed. These include:
In order to maintain its stability, the human body
factor Xa inhibitors (e.g. rivaroxaban, apixaban),
routinely balances between the formation of a
thrombus and its destruction. This constant
balance is achieved by complicated pathways
NACs have become more popular recently,
that involve platelets, the vascular endothelium,
and have been used for therapy and prophylaxis.
the coagulation cascade, and the fibrinolytic
Therefore, good knowledge of specific drugs,
system. The coagulation cascade consists of two
adverse events, possible complications, and the
main pathways: the contact activation pathway
recommended antidote is essential for physicians
(also known as the intrinsic system), and the
and practitioners. The proper knowledge will
tissue factor pathway (also known as the
lead to good clinical care and management.
extrinsic system). Both pathways work
However, our knowledge of adverse events of
independently, but end in factor X conversion
NACs is still limited, and we still do not have
into factor Xa, where the common pathway
sufficient information and evidences about
starts and leads to converting prothrombin into
these new anticoagulants [1].
thrombin. Thrombin later starts the formation of

fibrin, and the stabilization of platelets; causing
the formation of a stable clot[1].
· Data Sources and search terms
This complexity in homeostasis made it
difficult to be controlled with drugs, and normal
comprehensive search of MEDLINE, PubMed
anticoagulants usually require strict frequent
and EMBASEfrom January 1987 to March
monitoring. Otherwise, there is high incidence
2017. The following search terms were
of bleeding due to these drugs' narrow
therapeutic index. This inconvenience created a
unfractionated heparin, factor Xa inhibitor
continuous desire to come up with new safe
· Data extraction
anticoagulants that do not require this strict
Two reviewers have independently reviewed the
monitoring. Recently, many new anticoagulants
studies, abstracted data and disagreements were
Received: 10/12/2017 DOI: 10.12816/0044325
Accepted: 20/12/2017

Full Paper (vol.706 paper# 3)

c:\work\Jor\vol706_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 906-911

Nutritional Anemia Types and Management
Hawraa Ali Alaliwi1, Ghufran Abdulrahman Abukashba2, Hussain Musa Alhussain3,
Mohammad HamdinAlhasnani4, Saleh Hasan Alzahrani4, Walaa Saleh Alharthi5, Ali Ibrahim Sabei6,
Ahmed HeshamAlsharhan7, Wejdan Hassan Bagadood2, Sarah Ali Bunajimah8, Mohannad M. Alshaya9,
Roba Mohammed Hamdan10, Reem Moteb Alanazi10, Sara Ahmad Najmi11, Ismail Nizar Kraiz1, Rakan
Ahmed Alshuwaier1
1 King Saud University, 2 Ibn Sina National College, 3 Imam Abdulrahman Bin Faisal University,
4 Umm Alqura University, 5 King Abdulaziz University Hospital, 6 King Abdulaziz University,
7 Imam Muhammad Ibn Saud University, 8 Almaarefa Colleges, 9 King Saud Chest Hospital,
10 Arabian Gulf University, 11 Jazan University
Corresponding Author: HawraaAli Alaliwi- Dr.Hawraa-Alaliwi@Hotmail.Com - 0564555765

Nutritional anemia or anemia due to dietary causes is the most common form, yet, it is the easiest
to manage compared to other forms of anemia. Some of the most common nutritional deficiencies are iron,
cobalamin, folate, and also other elements like copper. Anemia due to diet is mostly asymptomatic in the initial
phase until the stores are depleted, which can take a few months to several years, depending upon the cause.

We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE fromJanuary 1987 toMarch 2017. The following search terms were used: nutritional anemia, dietary
anemia, iron deficiency anemia, cobalamin deficiency, folic acid deficiency anemia, dietary anemia treatment
Aim of the work: In this study we aimed at understanding the different types of anemia caused as a result of
dietary deficiency. We also briefly studied their presentation, pathophysiology, and treatment.
Conclusion: Various causes of anemia, presentations, and complications associated with the different types of
nutritional anemia, which is considered the easiest to treat and manage. Most cases are due to an underlying
occult disorder rather than simple dietary insufficiency. Diagnosis can be more difficult in some cases, and require
thorough history and investigations and integration to reach to an accurate conclusion and consequently treat the
underlying cause.
Keywords: dietary anemia, iron deficiency anemia, cobalamin deficiency, folic acid deficiency anemia, dietary
anemia treatment, nutritional anemia.



nutritional anemia is considered the easiest to manage
clinical features, which makes it easier to be reversed
and treat. In contrast to other anemia which could be
either spontaneously or by intervention[2].
corrected when enough vitamins and minerals ­

required are supplemented for erythropoiesis.
Whereas, other types of anemia depend mostly on
· Data Sources and search terms
We conducted this review using a comprehensive
pathophysiology. The prevalence of nutritional
search of MEDLINE, PubMed and EMBASEfrom
anemia is much less than other asymptomatic
January 1987 to March 2017. The following search
nutritional insufficiencies in the general population. A
terms were used: nutritional anemia, dietary anemia,
huge debate is raised about the necessity of treatment
iron deficiency anemia, cobalamin deficiency, folic
in mild cases if no other threat is present [1].
acid deficiency anemia, dietary anemia treatment
In this paper, we discussed these cases of
· Data extraction
asymptomatic nutritional insufficiencies with no
Two reviewers have independently reviewed the
symptom of anemia, and reviewed present data
studies, abstracted data and disagreements were
provided through the medical literatures. Nutrients
resolved by consensus. Studies were evaluated for
which are required at relatively higher quantity, major
quality and a review protocol was followed
acute loss, or low body stores are more likely to
progress into symptomatic anemia. Otherwise, these
The study was done after approval of ethical
deficiencies may take years before developing
board of King Abdulaziz university.
Received: 10/12/2017 DOI: 10.12816/0044326
Accepted: 20/12/2017

Full Paper (vol.706 paper# 4)

c:\work\Jor\vol706_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 912-915

Sharing the Experience of Management of Neonates with Maternal
Premature Rupture of Membranes
Abdullah Khalaf Almutairi, Muhammad Asad Farhan, Yousef Alhomaidi Alrohaimi
Majmaah University College of Medicine
Corresponding author: Abdullah Khalaf Almutairi - Abdullah_9998@hotmail.com , Tel: +966559993517

Neonates with the maternal premature rupture of membranes are commonly encountered in the
clinical practice. The condition has an important implication for the management of neonates, as it is associated
with certain risks of morbidity and mortality. The management varies among the physicians. The study aimed at
evaluating out the neonatal outcome of the existing condition with institutional practice.
Methods: The study was conducted at King Khalid Hospital, Al Majmaah KSA from August 2016 to August
2017. Two hundred neonates born to mothers with premature rupture of membranes were evaluated, monitored
and treated in neonatal unit. Septic screening was done in all the neonates and empiric antibiotics were started
for all the neonates. Maternal risk factors were taken into consideration. Neonatal outcomes were considered in
all cases.
Results: There were 111 male and 89 female neonates. Most of the cases were term prom while 68 cases were
pre-prom. Most commonly associated complication was feeding intolerance found in 16% of cases. Only two
neonates had a positive blood culture for group B streptococci. Maternal high vaginal swab yield group B
streptococci in 17 cases. Sepsis developed in three cases. One hundred and ninety eight neonates were
discharged home while one patient died of severe sepsis.
Conclusion: PROM is a common clinical entity that requires careful handling of the neonates to prevent the
mortality and morbidity. With prompt treatment, the outcome can be significantly improved.
Keywords: PROM ­ neonates ­ chorioamnionitis ­ complications ­ outcomes


Premature rupture of fetal membranes(PROM)
Neonatal outcomes are adversely affected if the
implies the rupture of membranes before the onset of
PROM is associated with chorioamnioitis.
the labor. PROM can occur at term or preterm.
Complications like fetal distress, cord prolapse,
PROM occurs approximately in 8-10% of all term
placental abruption, intra-ventricular hemorrhage,
pregnancies[1]. Prolonged rupture of membranes is
fetal and neonatal deaths are associated with PROM
considered when the duration is more than 24 hours
[2]. PROM is mainly a clinical diagnosis, which is
PROM is considered as a major risk for the
suggested by history of watery vaginal discharge
neonatal sepsis but there is lack of consensus on the
that can be confirmed by speculum examination[2].
treatment of the neonate without the evidence of
Preterm PROM is the leakage of amniotic fluid prior
infection [12].
to the onset of labor at less than 37 weeks of
Treatment of the mother following PROM is
highly variable; however, these treatments include
Pre-PROM accounts for 30-40 % all preterm
broad-spectrum antibiotics that aim to reduce the
deliveries [4]. Certain tests like nitrazine test can be
neonatal and maternal mortality thus improving the
used to confirm the diagnosis[5]. These tests are
outcome [13,14]. Considering the importance of
based on finding the pH of the amniotic fluid.
PROM, we conducted this study to evaluate the
PROM is a common and major cause of
impact of the disease and find out the outcome of the
neonatal morbidity and mortality. Early onset
neonates with our current institutional practice.
neonatal infection is the most serious complication

associated with PROM [6]. The risk of mortality is
increased to four times in presence of neonatal
This cross-sectional study has been conducted in
sepsis. Risk of neonatal sepsis increases with
King Khalid Hospital Majmaah from August 2016 to
increase in time from rupture of membranes to
August 2017.
eventual delivery[7].
Received: 11/12/2017 DOI: 10.12816/0044327
Accepted: 21/12/2017

Full Paper (vol.706 paper# 5)

c:\work\Jor\vol706_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1121-1122
Acquired Angioedema in a Patient with Chronic
Lymphocytic Leukaemia
Sultan S Alfadl, Mohammed A Alshehri, Yazid A Aljaizani, Othman M Alshabanah, Abdulhadi M
Alqahtani, Hazzaa A Alzahrani
King Faisal Specialist Hospital and Research Centre, Department of Haematology/Oncology,
Riyadh, Kingdom of Saudi Arabia
Corresponding Author: Mohammed Abdullah Alshehri, Telephone: +966536111145, Email: mamalshehri@gmail.com

Acquired angioedema (AAE) is defined by acquired deficiency of C1 esterase inhibitor. It is a rare disorder
characterized by recurrent angioedema without urticiaria, which may be associated with lymphoproliferative
disorders (LPD). We are reporting a case of 71 years old female, known case of Chronic Lymphocytic
Leukaemia (CLL) who presented to the emergency room (ER) with generalized body swelling during her
disease course. Investigations were ordered to confirm that the symptoms were due to acquired angioedema,
and the patient was managed for this diagnosis.
Knowing the association between acquired angioedema and lymphoproliferative disorder is crucial, because
AAE can be treated medically and responds within hours but delayed diagnosis can lead to unnecessary
invasive procedures or asphyxiation and death due to laryngeal oedema.
Finally, treating the underlying cause as CLL in our case could prevent further recurrence of angioedema.
Keywords: Acquired Angioedema, Chronic Lymphocytic Leukaemia, Lymphoproliferative Disorders.


One month later, the patient presented with
Acquired angioedema (AAE) is defined by
history of generalized non-erythematous body
acquired deficiency of C1 esterase inhibitor. It is a
swelling mainly in both upper limbs and in the left
rare disorder characterized by recurrent angioedema
upper eyelid that started four days prior to the
without urticiaria, which may be associated with
patient presentation to the ER.
lymphoproliferative disorders (LPD). It can cause
The patient denied allergy to food or any
severe abdominal pain mimicking an acute surgical
medication, any history of shortness of breath,
abdomen. Angioedema affects the skin, tongue,
wheezing, changes in her voice, newly medication
larynx, extremities and mucosal tissue of respiratory
introduced, herbal use, and family history of the
and gastrointestinal tracts, which leads to self-
same condition.
limited swelling of these tissues although laryngeal
Physical examination in the ER revealed blood
oedema can be fatal. AAE is similar to hereditary
pressure 134/53 mmHg, pulse 98 beats per minute,
angioedema (HAE) clinically but usually occur in
respiratory rate 18 cycles per minute, pulse oximetry
older age and associated with disorders like
of 96% on room air, and temperature 99.7 °F (37.6
°C). The patient was alert and oriented to person,
disorders, and infections especially H.Pylori
place, and time, not in pain or distress.
infection (1,2,3,4,5) . We are reporting a case of 71
Cardiopulmonary examination was unremarkable.
years old female, known case of Chronic
Abdomen was soft and lax, not tender. Skin
Lymphocytic Leukaemia (CLL) who presented to
examination showed non-erythematous swelling of
the emergency room (ER) with generalized body
the upper and lower limbs, lips and the lower lids of
swelling during her disease course.
both eyes. The patient had no pitting edema. Throat
The study was done after approval of ethical
examination showed patent airway with no evidence
board of KFSH&RC.
of tongue or throat swelling. The patient had

palpable cervical and supraclavicular lymph nodes.
The patient was started on IV Benadryl and
A 71 years old woman, known case of CLL,
Methylprednisolone. Four hours later, the patient
presented to the ER with mild swelling of both upper
suddenly developed shortness of breath and her
limbs and eyelids after taking Diclofenac. The
oxygen saturation dropped from 96% to 84% with
patient labeled to have a probable allergy toward
respiratory rate of 26 per minute, blood pressure was
Diclofenac and she received IV Hydrocortisone and
124/69 mmHg and heart rate was 108 beats per
IV Benadryl (Diphenhydramine) and discharged
minute. The patient was alert and oriented to person,
home with oral Cetirizine and Hydroxyzine. Her
place, and time and she was talking in clear
regular medications included calcium carbonate,
sentences. Chest examination showed no wheezing
vitamin D and baby aspirin.
with equal air entry bilaterally. Cardiovascular
Received: 25/10/2017 DOI: 10.12816/0044329
Accepted: 05/11/2017

Full Paper (vol.706 paper# 6)

c:\work\Jor\vol706_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 918-923

Assessment of Knowledge, Attitude and Practice towards Cervical-Spinal Injury
Among Adults in Dammam City, 2017
Ahmed Mohammed Al-Othman1, Faisal Hammad Alatawi2, Omar Mohammed Alshaikhi1,
Mohammed Nafy Alruwaily1, Moath Mohammad ALOthman3
1-King Faisal University, 2-Tabuk University, 3-Imam Abdulrahman Bin Faisal university University, Dammam

Spinal cord injuries (SCI) are life threatening and most prevalent crises around the world thus
the first aid from society population could be helpful for proper management by health care professionals
Objectives: Evaluate the KAP of Saudi adults toward CSIs in Dammam City, Kingdom of Saudi Arabia
(KSA). Methods: A cross sectional community questionnaire based survey that was carried out in 30
shopping malls of Dammam City among 700 Saudi subjects from May to July 2017.
Results: Most of the subjects (90.4%) had excellent and good knowledge about CSI, 58.9% had positive
attitude, 7.3% showed a right practice, while practice of 69.5% was right but not complete and the rest had
poor practice. There was a significant relation between knowledge score and Attitude score but not with the
practice score. Also, there was a positive relation between the practice score and the attitude score. The older
age and working status showed a significant relation with the knowledge score and the male showed a more
significant right practice compared to females.
Conclusion: Most of the subjects had significant knowledge, attitude. However, low level of right and
complete practices was obvious due to inadequate educational training programs attended by the participants
about first aid of CSI patients.
Keywords: Knowledge, Attitude, Practice (KAP), Cervical -spinal injury, adults, Dammam city, KSA.


Spinal cord injuries (SCI) are life
the detection of cervical spine injuries during
threatening and represent most of the prevalent
primary and secondary health care are important
crises around the world (1). Annual statistical
factors for avoiding additional injury of the spinal
reports estimated an average 20-50 subjects suffer
cord. However, identification of cervical spine
from SCI out of 1,000,000 subjects in the world
injury is a challenge especially during the
(2).Also, among those affected with cervical spine
evaluation of the initial trauma because most of
injuries, 10-50% of subject will suffer from SCI (3,
patients usually admitted with low level of
4). The mechanism of cervical spine injuries (CSIs)
consciousness due to sedatives, analgesic drugs,
are accidents due to motor vehicle (5), trauma or
concurrent head injury or endotracheal intubation.
falls (6, 7). The victims of cervical spine injuries are
In these circumstances, the first aid from society
males than females (8, 9). Also, the incidence rate of
population will be helpful for proper management
cervical spine injuries is higher among population
by health care professionals (9, 11). This study was
aged from 15-45 years or 65 to 80 years old (10, 11).
conducted to evaluate the KAP of Saudi adults
The CSIs can result from multiple blunt
toward CSIs in Dammam City, Kingdom of Saudi
traumatic injuries and will cause a devastating
Arabia (KSA).
sequel with many disabilities. Also, other disorders

that associated with CSIs are sensory and motor
deficits, requiring longevity medical and physical
Study design
management as well as bowel and bladder
It is a cross sectional community questionnaire
based survey that was carried out in 30 shopping
identification of CSIs is the issue of focus for all
malls of Dammam City from May to July 2017.
healthcare professionals among traumatized
Study population and sample size
patients (12). Also, the mechanism of injury has
The study included adult Saudi subjects who can
linked CSI with blunt multiple trauma, facial
read and write. After reviewing the whole
trauma, head injury and back bone injuries (9, 13-15).
population of Dammam City as shown by the
Another concern of researchers in early
General Authority for Statistics (GAS), KSA in
identification of these injuries is finding an
2016 (17), the sample size was calculated using the
association between CSIs and other specific
web calculator(18)with a response rate of50%, a
injuries to avoid tearing of spinal cord and thus
95% confidence interval and a margin of error of
prevent further complications and disabilities (16).
5%. The sample size was then increased to avoid
Controlling the spinal mobilization and enhancing
Received: 12/12/2017 DOI: 10.12816/0044331
Accepted: 22/12/2017

Full Paper (vol.706 paper# 7)

c:\work\Jor\vol706_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 924-934

Evaluation of Nutritional Quality of Green Tiger Prawn, Penaeus Semisulcatus
from Land Fisheries (Alexandria) and Market (India)
Ahkam M. El-Gendy, Fatten El-Feky, Neveen H. Mahmoud and Ghada S. A. Elsebakhy
Zoology Department, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt

Seafood in general, shrimps and prawns in particular, are highly nutritious with good
source of protein and amino acids. The present study was conducted to evaluate the nutrient value
in males and females of green tiger prawn, P. semisulcatus. Twenty specimen were collected from
land fisheries in Mediterranean Sea (Alexandria) and from markets (India). The results showed
that the highest values of lipid contents were measured in the female and male edible muscles (P.
at Mediterranean Sea (Alexandria) compared to female and male edible muscles of
the same species from market (India). The carbohydrate contents in the male edible muscles of P.
were higher compared to females in the studied regions. Sixteen amino acids have
been determined in edible muscle of P. semisulcatus, among these, nine essential amino acids
(EAAs) and seven non- essential amino acids (NEAAs) were estimated in both sexes from two
regions. The quantities of amino acids vary considerably between sexes. The fatty acid contents
from the muscles of the P. semisulcatus showed the presence of fifteen individual fatty acids,
which include seven saturated fatty, three mono and five polyunsaturated fatty acids (MUFA and
PUFA). Twelve protein bands were detected in males of P. semisulcatus (12 bands); while the
females had 13 bands from market (India) compared to 9 bands of both males and females from
Mediterranean Sea (Alexandria). Conclusion: The present study clearly indicated that the
nutritional value of P. semisulcatus is very well as food and health care.
Keywords: proximate composition, Amino acids, Fatty acids, Electrophoresis, P. semisulcatus,
Egypt, India.


season and physical activity [7]. Biological
Seafood in general, shrimps and
value of protein is obviously reflected upon
prawns in particular, are highly nutritious
its amino acids concentration. Amino acids
with good source of protein and amino acids
are the building blocks of proteins and serve
[1]. Shrimp is one of the most popular species
as body builders. Amino acids are important
as it is a part of almost every nation's
in osmoregulation and buffer capacity in the
traditional meal rich in protein and mineral.
tissues of aquatic animals [8] and some amino
Among seafood, shrimps contribute about
acids are involved in neurotransmission [9], it
20% by volume of the world seafood market
can be an important source of energy
[3]. Shrimps were identified as a rich source of
producing compounds [10]. Lipid of shrimp
contains mostly polyunsaturated fatty acids
unsaturated fatty acids (HUFA) and potent
(EAAs). These EAAs available in shrimp
natural antioxidants [4].
provide health benefits for human e.g., eye
The nutritive values of edible marine
(retina) and brain development and function
organisms depend upon their biochemical
[11]. Among the body organic nutrients,
composition, such as protein, amino acids,
Carbohydrates are considered to be the first
lipid, fatty acids, carbohydrate, vitamins and
substances to be utilized for the synthesis of
energy required for physiological activities.
sustenance of life and accordingly exists in
Carbohydrates serve as precursors for the
the largest quantity of all nutrients as a
synthesis of dispensable amino acids and
component of the human body [5]. Protein is
certain nutrients, which are in free and bound
essential for normal function, growth and
state along with proteins as protein-bound
maintenance of body tissues. Its content is
sugars and glycogen [12].
considered to be an important tool for the
Several studies are available on the
evaluation of physiological standards [6].
nutrient values of shrimps [13] from different
However, quantities of these constituents
regions all over the world. Therefore, the
objective of the present work was to evaluate
Received: 25/10/2017 DOI: 10.12816/0044332
Accepted: 05/11/2017

Full Paper (vol.706 paper# 8)

c:\work\Jor\vol706_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 935-938

Management and Follow-up of Dyslipidemia in Primary Health Care Setting
Faisal Hammad Aldossary1, LolowahEbraheem Alhammar2, Dhoha Ibrahim Al Abdalqadir3, Danah
Ibrahim Alabdalqadir3, Abdullah Saud Aloyaid1, Abdullah Khalid Alobaid1, AmnahEbraheem
Alhammar2, Abdulaziz Abdullah Mohammed Alharbi1, Mohammad Abdullah Alotaibi1, Renad
Mohammed Khalaf4, Abdulrahman Abdullah Alenazi1
1 Imam Mohammad Ibn Saud Islamic University, 2 King Faisal University,
3 Arabian Gulf University, 4 Ibn Sina College
Corresponding Author: Faisal Hammad Aldossary -scholar30@gmail.com - 00966542000750

Management of dyslipidemia is an important part of most practice guidelines with many
variations between these guidelines. Unfortunately, usually these guidelines are not followed widely on the level
of primary care, possibly due to insufficient qualification of health care staff in primary care, non-participation in
recent guidelines, and unrealistic target assigned to patients that leads them to non-compliance with medication
and follow-up. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed,
and EMBASE, January 2001, through February 2017. The following search terms were used: dyslipidemia,
primary health care dyslipidemia management, follow-up of dyslipidemia.
Aim: In this review, we aimed at evaluating the management expected from primary health care for risk
assessment, treatment and follow-up of patients with dyslipidemia.
Conclusion: Many guidelines exist for the proper management of dyslipidemia in the primary care setting.
Screening is crucial for preventing the cardiovascular sequelae of dyslipidemia. Management modalities include
lifestyle modification and pharmacotherapy, while the significance of follow-up cannot be neglected.
Keywords: primary health care dyslipidemia management, follow-up of dyslipidemia, statin therapy, non-statin


Managing dyslipidemia is an essential part of most
search terms were used: dyslipidemia, primary health
practice guidelines with several variations between
care dyslipidemia management, follow-up of
these guidelines. However, usually these guidelines
are not followed widely on the level of primary care.
· Data Extraction
A possible reason for this is the lack of sufficient
Two reviewers have independently reviewed the
qualified doctors working in primary care (about 17%
studies, abstracted data, and disagreements were
of physicians) and participating in the development of
resolved by consensus. Studies were evaluated for
these guidelines. Another reason is the unrealistic
quality and a review protocol was followed
target recommendations that many patients find very
difficult, especially the long-term adherence required
The study was done after approval of ethical
for chronic management and prevention[1].
board of Imam Mohammad Ibn Saud Islamic
Patients, who have marked elevation in lipid levels
despite lifestyle modifications, should be evaluated

Risk assessments
Moreover, usual guidelines are not applicable for
The best predictor of estimated improvement
these patients, and should follow specific
when on statins is the overall risk, rather than lipid
recommendations. In addition, hypertension is an
levels. The absence of a reliable risk assessment tool,
makes calculating the overall risk somewhat
management and cardiovascular disease (CVD)
challenging, for both patients and physicians. An
important reason for insufficient management of
high-risk patients may sometimes be the reliance on
· Data Sources and Search terms
lipid levels to predict improvement.
We conducted this review using a comprehensive
On the other hand, risk estimation improves
search of MEDLINE, PubMed, and EMBASE,
decision making and patient-physician relationship,
January 2001, through February 2017. The following
by discussing the baseline risk and potential benefits

of statins with the patient. About 25-35% decrease in
Received: 25/10/2017 DOI: 10.12816/0044335
Accepted: 05/11/2017

Full Paper (vol.706 paper# 9)

c:\work\Jor\vol706_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 939-942

Assessment of Knowledge, Attitudes and Practices of Expectant Mothers in
Relation to Antenatal Care in Abha
Roaa Fahad Alshabanah, Tahani Saeed Almohayya, Ebtesam Mohammed Alahmari
King Khalid University

Antenatal Care (ANC) is the care before birth that include complete screening, treatment,
promoting and monitoring of the safety of the mother and fetus.
Objectives: Assessment of knowledge, attitudes and practices of expectant mothers in relation to antenatal
care in Abha. Methods: This is a cross-sectional questionnaire based study conducted in Abha City from
August to October 2017among 300 expectant women from different parts of Abha city.
Results: Most of the subjects had appropriate knowledge about the importance of ANC visits which resulted in
good attitude and practice pattern among the majority of them. The majority of included women had good
knowledge about the importance of ANC visits for supplementing women with vitamins and folic acid, giving
them information about breast feeding and postpartum care, correct signs of labor, its importance for maintain
women and child health, importance of ANC visits for the fetal developmental stages, decreasing the rates of
maternal mortality, providing adequate knowledge about the danger symptoms and the complications of
pregnancy and the importance of booking, following up and delivering later in the same place that they booked
in. Conclusion: Most of the women had good knowledge, attitude and practice toward ANC visits.
The majority of the subjects were highly educated thus further large population studies are needed to be
conducted all over KSA cities and include rural areas.
Keywords: Knowledge, Attitude, Practice, Expectant mothers, Antenatal care (ANC), Abha, KSA.


Antenatal Care (ANC) is an important step which
Study design
means care before birth with complete screening,
Across-sectional study included a questionnaire
treatment, promoting and monitoring of the safety of
sheet distributed among a random sample of Saudi
the mother and fetus (1). The ANC could provide
pregnant females in Abha City from August to
pregnant women with valuable information and
October 2017.
advices that could help them during their pregnancy,
Study population and sample size:
delivery and postnatal period to avoid high rates of
The study included a random sample expectant
death that result from inappropriate knowledge about
pregnant women aged from 20-35 in Abha region
antenatal care (2, 3). During antenatal period,
who were interviewed in pharmacists, health care
supplementing pregnant women with folic acid,
facilities and shopping Malls. Using stratified
Calcium and important vitamins as well as
random sampling technique, 300 pregnant women
providing the mother with care and information
were enrolled in the presented study.
could assist the family to overcome pregnancy
Study tools

complications and promotion of breast feeding (3,
The data were collected after revising the previous
.Women should visit ANC four times during their
studies then the questionnaire was validated and
pregnancy period which would increase the chance
revised by 3 supervisors. The questionnaire was
for good skills attendant during the birth time and
based on previous study carried out in Madina
would increase the health during the longevity as
region in KSA (9) which included questions about the
well as management of death rates of the mothers
knowledge, attitude and practice pattern of women
and fetus during birth which was increased to reach
toward ANC.
25% of maternal death around the world (4-6). Few
studies were conducted in KSA to assess the
Ethical approval
obstacles and conflicts encountered by women
The questionnaire and study design were approved
including cultural and literacy level(7, 8). Also, the
by the experts and the faculty of Medicine. All the
knowledge of women about the importance of ANC
enrolled women received informed consent to
was not sufficient among the majority of them in
participate in the study.
Saudi Arabia. Thus, the authorities should raise the
Statistical analysis
public awareness of Saudi population toward this
The data were collected and fed into SPSS (22) for
issue. The present study aimed at assessing
windows. The descriptive data were shown as
knowledge, attitudes and practices of expectant
percentages and variables. Chi-square test was used
mothers in relation to antenatal care in Abha.
for assessing the difference between the two groups.
Received: 25/10/2017 DOI: 10.12816/0044337
Accepted: 05/11/2017

Full Paper (vol.706 paper# 10)

c:\work\Jor\vol706_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 943-947
Prevalence of Unplanned Pregnancy and Its Psychological
Effect among Pregnant Patients in King Khalid University Hospitals
Ahmed Abdulwahab1, Ahmad Almotairi2, Waleed Alkhamis2, Abdulelah Almutiari3
1. Obstetrics and Gynecology Department, King Saud University, King Saud University
Medical City, Riyadh, 2. King Saud University, College of Medicine, Riyadh,
3. Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Corresponding Author: Ahmed Abdulwahab E-mail: awkarim55@yahoo.com, Mobile No.: +966557715170

To identify the prevalence of unplanned pregnancy and the most common associated factors that
might increase the incidence along with psychological effect. Material and methods: Self-administrated
survey was conducted among pregnant women attending obstetric clinics during January, February and
March 2017 at King Khalid university hospitals. Of whom 358 answered the survey. SPSS version 22 was
used for completed and partial completed survey entry and analysis. Result: Prevalence of unplanned
pregnancy among pregnant women attending the clinics was (12.3%) and majority (53.1%) found to be
planned. We found that there were specific significant factors (age, gravidity and parity) which could play a
role in determining the pregnancy was either planned or unplanned. Unplanned pregnancy associated with
minimal psychological effect or distress when compared to planned pregnancy found when applied a
screening test. Conclusion: Unplanned pregnancy has been associated with poor outcomes to the mother and
baby along with psychological effect. Increasing the level of awareness and identifying the role of
contraception in preventing unplanned pregnancy need to be conducted.
Keywords: unplanned pregnancy, psychological effect.

among Saudi pregnant women attending the clinics
Unintended pregnancy is a general term that used
and to determine the characteristics that may
to describe unplanned, mistimed and unwanted
interfere with that prevalence along with
pregnancies1. Unplanned pregnancy has been
psychological effect.
associated with uncontrollable growth of

population which can be considered a major health
and socioeconomic problem2. Saudi population
Self-administrated survey was conducted
increased dramatically in the recent few years. for
randomly among pregnant women attending
example, from 2010 till 2016 the Saudi population
obstetric clinics at King Khalid university hospital,
increased 16.54%3. Unplanned pregnancy has a
Riyadh city Kingdom of Saudi Arabia during
negative impact on the family in which it is
January, February and March 2017. Of whom 358
associated with poor outcomes and psychological
completed the survey. We excluded IVF (In vitro
effects on women and child lives4,5. Women with
fertilization) patients or any type of induced
unplanned pregnancies are more prone to get
pregnancy, also any patient with pregnancy
depression and increase the desire to get abortion
complications and any pregnant women known to
when compared to women with planned
have psychological disorders and included
pregnancies6,7. Many women thought about
completed and partial completed surveys. We used
abortion or even underwent to abortion and some
26 instrumental survey (see appendix). Our survey
women after the delivery developed complication
contained 3 section. First section, socio-
and gave a low birth child8. In other study it was
demographic characteristics of the respondents.
estimated that 43% of women with unintended
Second section, we used London measurement of
pregnancy ended up with abortion9.
unplanned pregnancy (LMUP) which is considered
In 1999, 38% of pregnancies worldwide has been
validated measure to assess if the pregnancy was
estimated to be unintended or unplanned
planned or unplanned. By using 6 questions with
pregnancies10. Many studies were conducted
total score range from 0 to 12. If the final results
worldwide to estimate the prevalence of unplanned
for this scoring system from 0 to 3 is considered
pregnancy, for example in UK, the prevalence of
unplanned pregnancy, from 4 to 9 is ambivalent
unplanned pregnancy was 16.2%11. in the middle
and from 10 to 12 is planned pregnancy. Third
east, there was a study conducted In Sudan
section, we used Kessler 6-Item Psychological
suggested that the prevalence of unintended
Distress Scales (K6), which is a simple and
pregnancy was 30.2% and found that it is more in
screening measure for psychological effect like
high parity women12.Our aim in this study was to
depression and anxiety and each question scaled
estimate the prevalence of unplanned pregnancy
from 1 to 5 and the total score ranged from 6 to 30.
Received: 10/12/2017 DOI: 10.12816/0044339
Accepted: 20/12/2017

Full Paper (vol.706 paper# 11)

c:\work\Jor\vol706_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 948-954

Emerging Trends in Dental Specialty and Employment Choice Among Male
Dentists Graduating from King Saud University between 2005 and 2015
Sami Alshahrani 1, Nazish Masud 2 , Tariq Alswayyed 3, Hussain Masoud 1, Mothen Almothen 4,
Afaf Moukaddem * 2, Yasmeen Alshammari 5
1.College of Dentistry, King Khalid University Abha, 2. Department of Medical Education,
College of Medicine, King Saud bin Abdulaziz University for Health Sciences Riyadh,
3. Department of Advanced Restorative Dentistry, King Abdulaziz Medical City Riyadh,
4. Ministry of Health Riyadh, Saudi Arabia,5. Dentist at private sector
*Corresponding author: Afaf Moukaddem, Email: afaf_9@hotmail.com

Aim of the work:
specialization in any field is known to be associated with higher productivity. Postgraduate
dental education has a key role in providing the proper training for practitioners. This study aimed to assess the
dental specialization trends among dentists who graduated from 2005 to 2015.
Method: this observational descriptive study was conducted with the dental graduates of King Saud University.
The participants were identified randomly and contacted via telephonic communication based on the list provided
by the university academic affairs. The structured interview included 12 multiple choice questions to identify the
specialty preferences of the graduate dentists. Chi-square and Fisher's exact test were used where applicable. The
p-value < 0.05 was considered significant for all applied statistical tests.
this study included 233 dental graduates the majority of which were working in the government sector
(70%). Almost half of the subjects (49%) were general practitioners and had no specialization. Most of them had
an interest in a postgraduate degree with prosthodontics being the most aspired specialty (30%). The overall trend
of specialization between 2005-2015 showed a marked decline in both local and international post-graduation (p-
value 0.013). Conclusion: specialization in the Saudi dentistry field is experiencing a decline in the number of
graduates both locally and internationally. From here arises the importance of career and specialization orientation
especially among the final year students to guide them in choosing their future specialties, while considering the
needs and requirements of the community. This should be coupled with a proper recognition of the dental needs
of the Saudi population.
: dental universities; trends; dental specialties; dental graduates.


Specialization in any field is known to be
health needs and specialties should be only in areas
associated with higher productivity. The same applies
which require additional skills and expertise (4). In
to the healthcare sector in general and specifically to
addition to postgraduate qualifications leading to
dentistry where general practice is being rivaled with
specialist status, there were a variety of further
the increasing demand for specialization. Postgraduate
qualifications including Board Certification, Diploma,
dental education has a key role in providing the proper
Master's and Doctorate degrees, membership and
training for practitioners who meet the specific dental
fellowship. According to a recent research brief, the
health needs of society in areas where general
number of dentists per capita in the United States is
dentistry proved to be insufficient(1). This in addition
expected to steadily increase through 2035(5). This
to the academic roles that postgraduate dentists can
can imply an increase in both general practitioner and
lead in areas of teaching and research (1). The
specialist dentists. Several studies explored the
development of postgraduate dental education
specialization aspiration of both graduate and student
programs should occur only after proper planning and
dentists (6-14). A study showed that nearly 80 % of the
considering several factors such as societal need,
sample of UK dental practitioners were thinking of
professional development and socio-economic
continuing education in the form of a membership
aspects(2). Currently, the number of dental specialties
examination and 25 % were considering pursuing
according to the American dental association (ADA)
specialization; the most preferred specialty was
is nine specialties (3), whereas the Saudi Council for
restorative dentistry (10). Another study also showed
Health Specialties (SCFHS) recognized thirteen
that a quarter of dentists graduating over a period of
specialties. It should be noted that the ADA believed
four years pursued some type of postgraduate
that general practice can better serve the public dental
education with an increasing number of females with
Received: 10/12/2017 DOI: 10.12816/0044341
Accepted: 20/12/2017

Full Paper (vol.706 paper# 12)

c:\work\Jor\vol706_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 265-272

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

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


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

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

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

Full Paper (vol.706 paper# 13)

c:\work\Jor\vol706_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 961-964

Glanzmann's Thrombasthenia: Epistaxis Treatment and Outcomes in Children
Thikra Mohammed Alblowi, Fahad Nashmi Alshammari,
Bashayer Aqeel Alshammari, Ahmed Ali Elazab, Thamer Menwer Albilasi, Hind Jaza Alotaibi
Hail University, Collage of Medicine
Corresponding author: Thikra Mohammed Alblowi, mobile:00966599819903, E-mail: Thikra.alblowi@gmail.com

Glanzmann's Thrombasthenia (GT) is a rare inherited blood clotting (coagulation) disorder
characterized by the impaired function of specialized cells (platelets) which are essential for proper blood
clotting. Objectives: The present study aimed to assess the management steps of epistaxis in children with
GM disease and assess the clinical outcome and the success rate or field of management.
Methods: Data was taken via scanning all the patients' files in ENT clinic and 4 children with GM were
identified as receiving therapy. Furthermore, data collected from each file were primary complaint needing a
duration of hospitalization, intensive care unit (ICU) admission, coagulation management, hematologic
results, medical therapy administration, blood products transfusion and the surgical intervention performed.
With a total of 25 hospital presentations, the highest percentage of the present symptoms was for
epistaxis with 68% (17), then 16% (4) for gingival bleeding and 8% for each of menorrhagia and hematemesis.
Conclusion and recommendation: Our study carried out the most effective technique that control epistaxis
is Fresh Frozen (FFP) Plasma. The epistaxis in GT should be concern as sever threating life condition and
should be managed with effective treatment.
Keywords: Glanzmann's Thrombasthenia, epistaxis, disorder.


bruising, purpura, gingival bleeding, menorrhagia
Glanzmann's Thrombasthenia (GT) is a rare
and less
inherited blood clotting (coagulation) disease

categorized by the impaired function of

specialized cells (platelets) which are important
frequently gastrointestinal bleeding, hematuria,
for appropriate blood clotting. Prolonged untreated
hemarthrosis, muscle hematoma and central
or unsuccessfully treated hemorrhage can be life
nervous system bleeding (1). The Management of
threatening (2). Glanzmann thrombasthenia affects
epistaxis usually with nasal packing or application
males and females at the same stage (2).
of foam soaked in thrombin. It was stated that a
There was a study published in 2006; showed that
recombinant aspect VIIa product was agreed to
treat bleeding episodes or per operational
its incidence has been increased in consanguinity
managing when platelet transfusions through or
populations (9). Awidi reported that it was the
even without antibodies to platelets are not
second most frequent bleeding disorder in Jordan
operative. On the other hand, treatment that is
(8). There is difficulty to be distinguished from
considered as symptomatic and supportive as
other congenital platelet function defects on
consistent dental repair is an important role to
clinical ground alone (10). It is a severe autosomal
avoid bleeding from the gums. Also, hormonal
recessive inherited disease which is characterized
rehabilitation can be used to suppress menstrual
by failure of platelet aggregation in response to
stages. On other hand, genetic counseling benefits
adenosine diphosphate (ADP), epinephrine,
people with GT and their families (2). GT is
collagen, and thrombin and by absent or
considered a severe hemorrhagic disorder;
diminished clot retraction (1). The Symptoms are
moreover, the prognosis is outstanding with
usually observed at birth (neonates) or even during
careful supportive care (9).
infancy stage; where 300 cases have been stated
The present study aimed to assess the
It usually contains abnormal bleeding, which
management steps of epistaxis in children with
could be severe (2).
GM disease and assess the clinical outcome and
The most common clinical complained is
the success rate or field of management.
epistaxis episodes and some of them may have


sever bleeding after circumcision, surgery or
Data was taken via scanning all the patients'
dental extraction (1). Also, may they have other
files in ENT clinic and 4 children with GM were
clinical manifestations which included: easy
identified as receiving therapy. Furthermore, data
was collected from each file were primary
Received: 11/12/2017 DOI: 10.12816/0044344
Accepted: 21/12/2017

Full Paper (vol.706 paper# 14)

c:\work\Jor\vol706_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 965-973

The Prevalence of Asthma and its Related Risk Factors among the
Children in Riyadh, Saudi Arabia
Youssef Fayez Horaib, Esra Saleh ALAmri, Wala Rafa Alanazi*, Eman Ahmed Sharahili,
Abdulmajeed Mohammed Alolayah, Munirah Abdulrahman Alrobian
Almaarefa Colleges, Riyadh, Saudi Arabia.
*Corresponding author: Wala Rafa Alanazi, Email: Wala.r.alenezi@gmail.com, Mobile number: +966506120311

The prevalence of asthma has increased considerably in the last few years. This study aimed at
assessing the prevalence of asthma and its related risk factors among children in Riyadh, Saudi Arabia.
Methods: A cross sectional prospective study was carried out. Pretested well-designed questionnaires were
distributed during the period from May to October 2016.
Results: Parents of 1700 children out of 4000 have completed the questionnaire with a response rate of 42.5%,
1082 (63.6%) of them were male. Asthma prevalence among girls (14.4%) was higher than boys (12.4%), but
this difference was insignificant. Asthma prevalence was significantly higher among Saudi participants
(14.4%)compared to non- Saudi (5.9%). Nature of residency, the presence of a plant or presence of pets at home
had no significant effect on asthma prevalence. A smoking of family member and a history of asthma in the
family had an important association on asthma prevalence rate. The highest prevalence of asthma (29.7%) was
among the younger children (<3 years). Symptoms of asthma enhanced during exercise. The positive
association between asthma and both cough and breathlessness was noted. Asthma had no effect on schools
absenteeism, visiting or admission to hospitals. Body mass index had no effect on the prevalence of asthma.
Conclusion: The asthma prevalence rate among children was 13.1%, whereas, smoking and a history of asthma
in the family increased this rate. Further studies are recommended to investigate asthma prevalence based on
clinical and laboratory diagnosis to explore the link between asthma and obesity.
Keywords: asthma, prevalence, risk factors, Riyadh.


Asthma is considered the major common
finally deaths [2-5]. Although asthma is a non-curable
chronic disease in children; it is characterized by
chronic disease; it has a relatively low mortality
repeated attacks of breathlessness and wheezing.
rate compared to similar chronic diseases. Local
The prevalence of asthma has increased
reports in the Kingdom suggested that the
considerably in the last few years in many
prevalence of asthma is increasing in spite of the
countries. World Health Organization estimated
abundance of high quality health services and the
that 235 million people currently suffer from
availability of worldwide guidelines. For example,
asthma, thus, placing a huge burden on health
Al Frayh et al. [6] conducted a 9-year cross-
resources in many countries [1]. Asthma is one of
sectional study to compare the prevalence rate of
the most common chronic disorders in Saudi Arabia
asthma among school children living in different
as more than 2 million Saudis suffer from asthma. .
regions of the Kingdom (Riyadh vs. Hail, Jeddah
Under diagnosis and under treatment of asthma
vs. Gizan). This study had shown that the
resulted in a considerable burden on individuals and
prevalence of bronchial asthma among school
families and often limits individuals' actions for a
children in the similar individuals increased
lifetime. The prevalence of asthma is on rise in the
considerably from 8% in 1986 to 23% in 1995.
past few years in many countries including the
Furthermore, it indicated high exposure to
Kingdom of Saudi Arabia (KSA). The impact of
environmental causes of asthma (smoking and
asthma is not confined to the patients themselves,
indoor pets), probably through fast changes in the
but their families and the community are also
lifestyle of Saudi society (effects of modern life). A
affected. The socioeconomic consequences of
cross sectional questionnaire study was carried
asthma are manifested in terms of losing work and
using 1,020 urban and 424 rural 12-year-old
school absenteeism, low quality of life, repeated
children. The prevalence of allergic symptoms was
visits to emergency rooms, hospitalizations, and
significantly higher in urban children than in rural
Received: 11/12/2017 DOI: 10.12816/0044345
Accepted: 21/12/2017

Full Paper (vol.706 paper# 15)

c:\work\Jor\vol706_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 974-979

Mitochondrial Translocase Expression Profile in Renal Cancer
Belal Ahmed Soliman1, Mohamed Hassany Ali1, Eman Ali Toraih2,
Mohamed Abdelhamid Hasan Ahmed3
1 Department of Zoology, Faculty of Science, Suez Canal University,
2 Department of Histology and Genetics, Faculty of Medicine, Suez Canal University,
3 Department of Pathology, Faculty of Medicine, Suez Canal University
Corresponding author: Mohamed Hassany, E-mail:mhassany_dna@yahoo.com

mitochondrial appropriate function depends on ideal mitochondrial translocation machinery, of
which translocase of outer mitochondrial membrane (TOMM) have a vital role in normal functioning cell.
Any disturbance in the translocation machinery leads to either tumorigenesis or apoptosis.
Aim of the work: This study aimed to investigate the expression of TOMM34 in renal cell carcinoma (RCC).
TOMM34 expression was assessed in 42 samples of RCC patients using immunohistochemistry technique.
Results: immunohistochemical staining revealed significant accumulation of TOMM34 protein in RCC cases
compared to their corresponding non-cancerous renal tissues. TOMM34 protein expression was significantly
associated with age and gender categories in contrast to the other clinicopathological features.
Conclusion: according to protein expression level this study demonstrated that TOMM34 is a marker of poor
outcome in RCC.
Keywords: RCC, TOMM34, IHC.


Renal cell carcinoma accounts for 3% of all
malignant tumor types and is considered the most
machineries for proper function, including
lethal of urologic cancers. Renal cell carcinoma
translocase of outer mitochondrial membrane
arises from the renal epithelium and accounts for
(TOMM) machinery. A part of TOMM
roughly 90% of renal malignant tumors. These
components, TOMM34 were identified from
tumors are more common in male cases than
expressed sequence tag (EST) and cDNA
females by 3:2 ratio. This type of malignant
databases as an important component of protein
tumors is hereditary in only 3-5% of cases and is
importing (3). TOMM34 plays a vital role in the
more common to be sporadic. Among many of
delivery of preproteins from cytosol to the TOM
signs, pain and hematuria are potential
complex; the protein interacts with the mature
representing signs, also vascular tumor thrombus
portion of the targeted protein. This protein is
may present. Renal cell carcinoma showed
found in the cytoplasm and associated with the
metastatic feature in many sites including, lung,
outer mitochondrial membrane. TOMM34 was
lymph nodes, liver, bone and brain (1).
described to be found on the surface of the outer

For this lethal tumor, many markers have been
membrane, later studies reported that TOMM34 is
studied in order to predict the behavior of renal
localized in the cellular cytosol and works as a
cell carcinoma, this prediction of invasiveness and
component of a large chaperone, which transports
metastatic potential of renal cell carcinoma at an
protein to mitochondria (3,5).
early stage is one of the most important challenges
A recent study identified TOMM34 as a co-
of cancer research. None of the available markers
chaperone with HSP70 and HSP90 by their
considered an ideal marker for prognosis,
simultaneously scaffolding for importing and
diagnosis, monitoring the treatment response of
maturation of preproteins (5,6). Inhibition of
renal cell carcinoma (2).
TOMM34 could be a good choice as an anticancer

Mitochondria are a vital organelle in cell
drug and promising target for immunotherapy, as
providing the needed energy and regulating
suppression of TOMM34 resulted in inhibition of
cancerous cell growth (4).
mitochondrial bioprocesses lead to either cell death

or development in to tumor cell; also they have
been reported as a common and consistent
Patients and tumors
phenotype of cancer cells and suspected feature of
The study was conducted on a well-
cancer development and progression (3,4).
characterized series of renal cell carcinoma

retrieved from archives of Pathology Department,
Received: 18/10/2017 DOI: 10.12816/0044346
Accepted: 18/10/2017

Full Paper (vol.706 paper# 16)

c:\work\Jor\vol706_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 980-981

A Testicular Torsion and Contralateral Hydrocele in a Neonate
Mohammed S. Albarrak, Ali H. Alameer, Ashjan Ali Albarrak
Department of Pediatric Surgery, Maternity & Children Hospital, Alahsa,Saudi Arabia
Corresponding Author: Mohammed S. Albarrak, E-mail: Mohammed21110005@gmail.com

A testicular torsion is an acute surgical emergency which needs a prompt work up. Neonatal
testicular torsion is an uncommon event.
Aim of the work: This article aim to describe a case report of a neonate presented with testicular torsion and
contralateral hydrocele.
Results: Clinical and radiological management were discussed.
Conclusion: The case demonstrated that the possibility of uncommon presentation of acute scrotum such as
testicular torsion with contralateral hydrocele can occur.
Keywords: Testicular torsion, Neonate, Acute scrotum.


A testicular torsion is an acute surgical
rate of 52 breath per minute and 100% oxygen
emergency and need a prompt work up. Neonatal
saturation on room air. The baby was irritable and
testicular torsion is an uncommon event occurring
crying, not pale jaundiced or cyanosed. There was
at incidence of 6 per 100,000 live births [1]. In
no apparent dysmorphic features or congenital
many cases of neonatal testicular torsion, a
contralateral hydrocele may be appreciated. The
genitalia revealed normal looking external male
incidence of hydroceles in term newborns with no
genitalia with bilateral scrotal swelling, more on
other scrotal pathology has been reported to be
the left side.
between 1% and 5% [2].
Overlying skin color was normal. Left testicle was
The study was done after approval of ethical
enlarged, hard and tender. Right testicle was
board of Maternity & Children Hospital,
mildly enlarged but not hard or tender. Laboratory
investigation were within normal level.

Scrotal ultrasonography showed diffuse scrotal
skin thickening donating scrotal edema. Left
An hour old full term baby via normal
testis was enlarged as well as the epididymis with
spontaneous vaginal delivery referred to us with
heterogeneous echogenicity, measuring 10 x 9
history of bilateral scrotal swelling. The baby`s
mm, and no clear internal vascularity which raised
mother was healthy with unremarkable antenatal
the possibility of testicular torsion. The right testis
history. On examination, patient was vitally stable
epididymis were
with temperature of 37°C, heart rate of 146
and echogenicity. Large right sided hydrocele was
beat per minute, blood pressure 63/32, respiratory

Figure (1): US of the left testis
Received: 12/12/2017 DOI: 10.12816/0044347
Accepted: 22/12/2017

Full Paper (vol.706 paper# 17)

c:\work\Jor\vol706_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 982-989

Comparison of Cotinine Salivary Levels Between Smokers,
Smokers and Non-Smokers Passive
Arwa Ahmad Fallatah, Rania Hanafi, Ibtesam Afifi
Umm Alqura University
Corresponding author: Arwa Ahmed Fallatah,emil: arwaafallatah@gmail.com, 966545944153

Cotinine is the predominant metabolite of nicotine which found in tobacco. At present,
smoking cigarettes and hookah are on the rise in the Middle East countries; therefore, the number of people
exposed to passive cigarette smoking is increasing too. Objective: To compare the salivary cotinine level in
saliva in smokers, non-smokers, passive smokers. Also to combat the wrong opinion that hookah is not
Material and methods:
In this cross-sectional study, unstimulated salivary samples were collected from 30
female subjects including students and workers at College of Dentistry, Umm Al-Qura university, Makkah.
The study participants were divided into 3 groups (each of 10 subjects) aged 19-50 years;
o First group: with history of cigarettes or hookah smoking at least one session/day for 20-30 minutes for at
least 2 years.
o Second group: exposed to cigarette smoke or hookah.
o Third group: non-smoker.
TheNicAlertTM (NYMOX pharmaceutical corporation, Canada) nicotine saliva test was used to determine
salivary levels of cotinine.
Results: Salivary cotinine level was detected in all study groups with the different levels. The highest level
was in a group of smokers while 50% of non-smokers showed level one. There were no significant
differences in salivary cotinine levels between hookah, cigarette and both smokers and a significant relation
between duration and salivary cotinine level.Also a non-significant relation was found between age and
salivary cotinine level.
Salivary cotinine levels were higher in smokers compared to passive smokers and non-smokers,
in descending order.
Keywords: cotinine-smokers-smoking-passive smokers-hookah.

smoking and exposure to second-hand smoke
Smoking is a world health problem. More
resulted in an estimated 443,000 deaths and 5.1
than one billion people (1 billion men, 250 million
million years of potential
women) smoke in the world resulting in 4.2

million annual deaths. It causes many systemic
life lost (YPLL) annually in the United States
problem including cancer of lung, oral cavity,
during 2000-2004[2].
pharynx, larynx, oesophagus, pancreas, urinary
The main alkaloid of tobacco is Nicotine,
bladder, and renal pelvis, nasal cavities and nasal
which is responsible for its addictive effect. It is
sinuses, oesophagus (adenocarcinoma), stomach,
easily absorbed from tobacco smoke; in regular
liver, kidney (renal cell carcinoma), uterine cervix
smokers, its concentration rises over 6-8 hours
and myeloid leukaemia, in addition to premature
during the day. About 70 to 80% of nicotine is
aging[1]. Tobacco smoke contains over 4800
metabolized to cotininewhich is the main
different chemicals out of which 69 are
metabolite of nicotine. It's half-life in the body
carcinogens, and several are tumors promoter or
(12-20 hours) is longer than that of nicotine (3-4
cocarcinogens. It has been reported that the
hours). Nicotine has been widely used as a specific
exposure duration to tobacco smoke is much more
biomarker of tobacco exposure. Cotinine is
important than the daily number of cigarettes.
suitable for assessment of doses over long periods
Quitting as early as possible remains the most
of time (weeks or months, in hair or nails) or short
powerful factor in reducing the cancer risk[1]. The
periods of time (from 1 to 10 days, in urine,
presence of carcinoembryonic antigen (CEA) in
plasma, or saliva).
greater than normal value may indicate the
Thus cotinine concentration is feasibly used in
presence of cancer and chronic inflammation,
epidemiological studies as a biomarker. Cotinine
Heavy smoking might also raise blood CEA
concentration has been used to describe and
levels[1]. In 2008, CDC reported that cigarette
compare patterns of tobacco consumption in
Received: 12/12/2017 DOI: 10.12816/0044349
Accepted: 22/12/2017

Full Paper (vol.706 paper# 18)

c:\work\Jor\vol706_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 990-993

Awareness of Systemic Lupus Erythematosus among
Students in King Faisal University
Abdullah Ahmed AlKhalaf, Rasha Ghaleb, Mustafa Hussain Al Shawaf, Ammar Ahmed
Abdrabalnabi, Abdullah Ahmed Al-Shabib, Ahmed Hassan Al-Khatem, Yousif Taher Al Malak,
Hussain Ali Al Qattan, Hashim Essa Al-Khalaf
Faculty of Family Medicine, King Faisal University
*Corresponding author: Abdullah Ahmed AlKhalaf , E-Mail: abdullah1e@hotmail.com

: Systemic lupus erythematosus (SLE) is an autoimmune disease where the body's immune
system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.
: to assess knowledge toward Systemic Lupus Erythematosus (SLE) among Students of King Faisal
Subjects and Methods: this is a cross-sectional study enrolling 161 students at King Faisal University to fill
a survey on SLE awareness. The study targeted students of computer science, engineering, science and
education colleges. The data was analyzed using SPSS software version 20.
Results: the study reported that 98 students (60.9%) have no idea about SLE. The majority of respondent did
not have clear idea regarding diagnostic, treatment and complications of disease. 55.9% respondent had idea
that SLE is more prevalent among men. However, this disorder is reported more prevalent in women.
Conclusion: this cross-sectional survey indicates that the students have low awareness and some
misconception regarding the SLE. Therefore, the awareness programs are needed to increase the awareness
about SLE, as these campaigns have proved that public awareness might be helpful to manage and control
disease and associated complications.
Keywords: autoimmune diseases, SLE, Lupus Erythematosus, King Faisal University


Systemic lupus erythematosus (SLE) is a
questionnaire from a previous study taken) (3) were
multi-systemic autoimmune disorder and affects
distributed among students during class hours. The
several organs and organ systems. The symptoms
questionnaire consists of demographic data of the
are wide ranged and clinical diagnostic of SLE is
participants, student`s knowledge about SLE
complex procedure (1). Awareness on SLE is
towards clinical manifestations, diagnosis, treatment
generally poor. In the period 1970-2001, Moriarty et
options, prevention and mortality.
al. (1) studied the level of awareness among the

Portuguese population and found that only 34.2% of
Statistical analysis
the population was aware of the condition. A new
Data analysis was performed using SPSS
research among female students of King Saud
version 20 (IBM, Armonk, NY, USA).
University shows low awareness, with a number of
The study was done after approval of ethical
misconceptions. Future educational campaigns are
board of King Faisal university.
needed to increase awareness and rectify

misconceptions (2).The increase in awareness level
would reduce the time of diagnosis and make it
more convenient to manage the disorder. Hence, this
One hundred and sixty one participant
study was carried out to assess the awareness level
students completed the questionnaire and were
about SLE among the students of King Faisal
included in the study. Participant students were
University, Al-Hasa (Saudi Arabia).
100% being of Saudi Nationality, and 84 were male.

The number and percentage of students from the
College of Computer Science, Engineering, Science,
This is a cross-sectional study, 161
and Education were 39 (24.2%), 34 (21.1%), 49
participant students from computer science college,
(30.5%) and 39 (24.2%) respectively.
Engineering college, Science college, and Education

college in King Faisal University in Al-Hasa in the
Knowledge on SLE
year of 2017/2018 were included in the study. The
63 (39.1%) respondents have previously
study was approved by the Ethical Committee of the
heard or read of SLE, while the majority 98 (60.9%)
college of medicine. Questionnaires (most of
have never heard or read the term SLE. 66 (41.0%)
Received: 25/10/2017 DOI: 10.12816/0044350
Accepted: 05/11/2017

Full Paper (vol.706 paper# 19)

c:\work\Jor\vol706_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 994-1006

Combinational Effect of 5-Flourouracil and Resveratrol against
N-Nitroso-N-methyl urea Induced Colorectal Cancer
Belal Ahmed Soliman1, Abdel Razik Hussein Farrag2,
Howayda Al Sayed Khaled1, Alyaa A.Mostafa Mohamed 1
1Zoology Department, Faculty of Science, Suez University, 2Pathology Department,
National Research Center
Corresponding author: Aliaa Gh , email: i gh h


Background: colorectal cancer is considered to be the third most common cause of deaths in both men and
women. The incidence of colorectal cancer cases has been rising at an alarming rate. In most cases, colon
cancer treatment involves chemotherapy. However, toxicity and tumor cell drug resistance are outstanding
obstacles to this treatment. Scientific studies suggested that combining certain chemotherapy treatments with
specific antioxidants at defined dosages can improve drug efficacy or may reduce side effects severity.5-
Fluorouracil, which is used in the treatment of breast, stomach and pancreatic cancer, remains the cornerstone
of CRC treatment, although widely used in combination with several other drugs. Many effective drugs,
including those actually used for cancer treatment, have been developed from botanical sources. Resveratrol is
a pleiotropic phytochemical which is belong to the stilbene family. Although, it is only significantly present in
grape products. Many preclinical studies investigated its anticancer properties in a plethora of cellular and
animal models. Aim of the work: in the present study, the anticancer effects of Resveratrol alone or combined
with 5-Fu were assessed on experimentally induced colorectal cancer in rats. Results: the results of this study
indicated that RES had a better therapeutic effect against N-methylnitrosourea induced colorectal cancer than
5-Fu alone and when in combination with each other they diminished the cytotoxic effect of 5-Fu and
enhanced normal histological appearance of colon tissue, which could be a promising alternative for resistant
colorectal cancer. However, the exact mechanisms involved needs to be further explored. Conclusion: our
results suggested that both natural compounds could be in the future a possible alternative to enhance the
efficiency of 5-Fu in resistant colon cancer cells. This study supports the potential of plant extracts as source of
bioactive compounds with biomedical applications.
Keywords: colorectal cancer, resveratrol , 5-flourouracil.

have been reported (8). Studies have confirmed that
Cancer is an expression used for diseases
res combined with other chemotherapeutic drugs
in which abnormal cells divide without control and
can be more effective at treating drug-refractory
are able to invade other tissues(1). Colorectal cancer
cancer cells (9). In one study , resveratrol potentiated
(CRC) is the second leading cause of cancer-related
the therapeutic efficacy of temozolomide, an
mortality, with 655,000 deaths worldwide annually
alkylating agent used in cancer therapeutics, in a
(2,3). Large steps have been taken toward the
mouse xenograft model of malignant glioma,
development of an animal model for studying
through inhibiting ROS/ERK mediated autophagy
colonic cancer. Intestinal tumours, both adenomas
and enhancing apoptosis (10).
and carcinomas, can be induced in some animals by
The procedure can be used to defeat many
a variety of methods. Among the most effective
problems including poor solubility or absorption,
were 1,2­dimethylhydrazine and azoxymethane (4).
patient acceptability, drug instability and toxicity
Numerous studies have shown that rats, which
and especially drug resistance (11). After the entry of
rarely develop cancer spontaneously, are good
a mutual prodrug into a cancer cell, the two active
animals to use for the induction of intestinal
components can reach the target at the same time
tumours by these chemicals (5). For the last 70
and are liberated parallel, whereas they might be
years, the fluoropyrimidine 5-fluorouracil (5-FU)
transported to the same site with different efficacy
has been positioned as a first line chemotherapy in
when administered alone. This type of prodrugs can
the treatment of various cancers including
demonstrate a broader antitumor spectrum, less
colorectal, head, neck and breast cancers(6,7) .
drug resist
nce and less toxicity (12). Resveratrol is a
5-FU is a poor tumor selective and therefore its
naturally occurring phytoalexin, a material
therapeutic use results in high incidence of bone
synthesized de novo by plants, to offset pathogen
marrow, gastrointestinal tract and central nervous
infections. In preclinical study, resveratrol has been
system toxicity. To tackle these problems, a series
shown to improve vascular health by reducing
of 5-Fu prodrugs in which 5-Fu is attached to
hypertension and counteract against heart failure
amino acids, peptides, phospholipids, and polymers
and ischemic heart disease in experimental animal
Received: 21/10/2017 DOI: 10.12816/0044352
Accepted: 01/11/2017

Full Paper (vol.706 paper# 20)

c:\work\Jor\vol706_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1007-1011

Diagnosis and Management of Gastrointestinal Stromal Tumor in the
Upper Gastrointestinal Tract- Case Report
Aqeel Jazaa Alshammari*1, Khaled Mandeel Hammod2, Fouad Taiwilaa Alshammari 1,
Saleh Muflih Alghaythi1, Sattam Saad Alshammari3
1College of Medicine, University of Hail, 2King Khalid Hospital, Hail,
3College of Dentistry, University of Hail, Saudi Arabia
Corresponding author: Aqeel Alshammari, E-mail: aqeel42@hotmail.com
Aim of the work: gastrointestinal stromal tumours (GISTs) are a type of mesenchymal tumours of the
gastrointestinal (GI) tract. The tumour can originate anywhere from the oesophagus to the rectum, but most
often comes from the stomach or small intestine. Despite the fact that GISTs are the most common
mesenchymal neoplasms of the GI tract, they remain a diagnostic challenge because of the overlapping
clinicopathologic features with GIST. Large GISTs are usually associated with complications such as
gastrointestinal (GI) haemorrhage, GI obstruction, and bowel perforation. GISTs are predominantly found in
people in their 60s, but a small population can develop it a younger age. Patient and methods: this was a
report the case of a 65-years old male presented to our hospital with upper gastrointestinal bleeding. Results:
vomiting and severe anaemia findings were detected in diagnostic image studies which suggested a gastric
GIST without evidence of metastatic disease; therefore, totally tumour excision was performed. Cytologic and
inmuno-histochemistry analysis confirmed diagnosis of GISTs.
Conclusion: the present case report highlighted the need of early recognition and appropriate investigation of
gastrointestinal symptoms at all ages for ruling out potential malignancy.
Keywords: gastrointestinal stromal tumours, GIST, endoscopic ultrasonography, mesenchymal tumours.


Stromal or mesenchymal tumours that affect
report a case of gastric GIST diagnosed with
the gastrointestinal tract typically appeared as
specimens obtained by EUS-FNA with a 25G
subepithelial neoplasms and they are classified in
biopsy needle.The study was done after approval
two groups. The most common is Gastrointestinal
of ethical board of Hail university.
Stromal Tumours Group (GIST), which arise from
A 65 years old male admitted to the emergency
differentiate into interstitial cells of Cajal in the
unit under hematologist care.
myenteric plexus [1]. Gastrointestinal stromal
He was suffering from anemia (Venous blood tests
tumour (GIST) is a gastric submucosal tumour
revealed a hemoglobin level of 6 g/dL) and had
(SMT), and it originates from the interstitial cells of
vomiting 3 days before admission, he also
Cajal. Around 40% of GISTs occur in the stomach.
mentioned back pain and renal failure symptoms
Gastric GIST is treated with surgery, including
(Oliguria and Itching).
laparoscopy, endoscopic mucosal resection, or
Meanwhile, patient's historical medical record
endoscopic submucosal dissection and imatinib is
revealed no past medical or surgical history (no
used for the treatment of GIST [2]. Most
hypertension HTN or diabetes Miletus DM)
subepithelial tumours do not cause symptoms and
Moreover, the patient had no history of
are usually discovered incidentally during the
medications for chronic diseases.
endoscopic or radiologic examinations. The
The work up started to rule out multiple myeloma
overlying mucosa usually appears smooth and
(Anemia ,renal failure ,bone changes and high ESR
normal at endoscopy. If symptoms do occur, they
96) through laboratory blood test, the results came
are nonspecific such as abdominal pain,
as follows:
obstruction, haemorrhage and intussusceptions [3].

Large submucosal neoplasms may outgrow their
ESR= 96
blood supply, ulcerate through the mucosa and
Bence-Jones proteins test result was negative
present as GI bleeding. Firm subepithelial tumours
Blood smear test was negative.
may also present with obstructive symptoms,
After resuscitation and stabilization, he underwent
especially if they are located near the cardia or the
to upper GI endoscopy under sedation. Endoscopy
pylorus. Subepithelial tumours obstruct the major
was performed in 3 phases as illustrated in figures
or minor papilla may cause jaundice or pancreatitis.
1- 3. Endoscopic Ultrasonography findings
Pain and weight loss often associated with large
suggested that volvulus could be excluded (surgical
submucosal GI stromal tumors (GISTs), are
case), but the appearance revealed that it was part
symptoms that suggest malignancy [3]. Here, we
of the stomach slipped through the pylorus).
Received: 13/12/2017 DOI: 10.12816/0044353
Accepted: 23/12/2017

Full Paper (vol.706 paper# 21)

c:\work\Jor\vol706_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1012-1024

Eosinopenia as a Diagnostic Marker of Sepsis in Critically Ill Patients
Mahmoud A. Salem, Mohammed A. Ali, Ashraf M. Hazem, Hoda S. Abdelsamie
Department of Anesthesiology, Intensive Care Medicine and Pain Management
Faculty of Medicine, Ain shams University
Corresponding author: Mahmoud A Salem; Mobile:01018873678, Email: mahmoudalisaad28@gmail.com

sepsis refers to the presence of a serious infection that correlates with systemic and
uncontrolled immune activation. Few studies had analyzed eosinophil count as a prognostic marker of
outcome in patients with infection. Eosinopenia is an interesting biomarker because the eosinophil count is
always measured in clinical practice and the additional costs would therefore be negligible.The aim of this
this studyaimed to test the value of eosinopenia in the diagnosis of sepsis in critically ill patients
admitted to ICUs. Patients and Methods: this prospective observational, randomized study was conducted
on 50 adult critically ill patients who were admitted to ICU of Ahmed Maher Teaching Hospitalin the period
from March 2017to July 2017. They either had sepsis on admission or not. An informed written consent was
obtained from patients and/or relatives before starting this study. Inclusion criteria were patients more than
18 years old and less than 60 years that were critically ill either in sepsis or not. Exclusion criteria were
patients less than 18 years old and more than 60 years old, patient or relatives who refused to be included in
this study, those with hematological cancer, HIV infection, bronchial asthma and other atopic disorders like
hay fever, atopic dermatitis and allergic conjunctivitis and increased levels of eosinophil count as part of any
parasitic infection or trauma patients. Results: comparison between infected and non-infected studied
patients was statistically significant as regard variables of SOFA score, APACHE II score at admission, TLC
and Eosinophil count at admission (p-value0.05). There were no statistical significant differences as regard
length of ICU stay (p0.05). Multivariate regression analysis showed statistically significant differences and
was independent predictors for infection as follow: total leucocytic count, eosinophil count at admission and
SOFA score. The AUC for eosinophil count to predict was 95% with optimal cut off value was 50 cells/mm3
with a sensitivity of 92.85% and specificity of 93.33% with P value <0.001.Conclusion: the result of the
present study revealed that eosinophil counts was 50 cells/mm3 at admission time to ICU was a predictor
for diagnosis of sepsis in critically ill patients. However, eosinophil counts at admission time to ICU were
not a specific indicator of mortality. Recommendations: eosinophil counts are cheap and easily accessible
test can be used to guide for sepsis diagnosis and treatment.Larger studies are needed to determine the
prognostic value of this test and establish better cutoff values.
Keywords: eosinopenia, sepsis, critical patients, adult.

a reliable marker to discriminate the inflammatory
Sepsis refers to presence of a serious
response to infection from other types of
infection that correlates with systemic and
inflammation. Gold standards for the diagnosis of
uncontrolled immune activation (1). Patients die as
infection do not exist, but procalcitonin is known to
a result of organ failure as the disease elicits an
be among the most promising sepsis markers in
exacerbated and damaging immune response with
critically ill patients and is capable of
approximately 250,000 cases leading to fatalities
complementing clinical signs and routine laboratory
in the USA annually (2).Owing to the broad and
variables that are suggestive of sepsis(6).Several
vague definition of sepsis along with its various
biomarkers, such as C-reactive protein and
manifestations and severity levels in different
procalcitonin,have been used to indicate bacterial
patient populations, a definitive biomarker that can
infection. These biomarkers could also provide
aid in therapeutic strategies could be difficult to
prognostic information in distincting infectious
scertain. More than 100 different molecules have
processes and in patients with sepsis(7).
been suggested as useful biomarkers of sepsis
A study analyzed eosinophil count as a
(3).The international sepsis forum colloquium on
prognostic marker of outcome in patients with
biomarkers of sepsis was convened in 2005 to
infection, but its utility as a marker of outcome in
develop a systematic framework for the
patients with bacteremia was unknown(8).
identification and validation of biomarkers of
A study used eosinophil counts,
sepsis (4).The diagnosis of sepsis is difficult,
specifically eosinopenia, as a marker of infection
particularly in the ICU where signs of sepsis may
(9)and as an indicator of bacteremia, but theresults
be present in absence of a real infection (5).The
were controversial.Eosinopenia would be an
effort of many investigating groups has been to find
interesting biomarker because the eosinophil
Received: 25/10/2017 DOI: 10.12816/0044354
Accepted: 05/11/2017

Full Paper (vol.706 paper# 22)

c:\work\Jor\vol706_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1025-1029

Assessment of Self-Awareness and Perception of Diabetic Foot
Disease among People with Type 2 Diabetes Mellitus in Tabuk
Ahmad Awadh Alatawi, Mohammed Hamad Alrashedi, Abdulelah Mohammed Alqarni,
Abdullah Hamad Almotiri, Sultan Saleh Albalawi, Mohammed Abdullah Alshamrani,
Abdulelah Faiz Alasmari
Faculty of Medicine, University of Tabuk, Tabuk/ KSA
Corresponding Author: Ahmad Awadh Alatawi, Email: qqqzy0@gmail.com,Telephone: +966 544918175

effective self-management of type-2 diabetes mellitus (T2DM) is crucial to reduce the risk of
diabetes-specific complications. Self-management activities included adherence to diet and nutrition advice,
physical activity, taking mediations as prescribed and weight and stress management. Evidence suggested that
there is poor adherence to self-care practices among diabetes patients globally. Thus, it has become necessary
to identity factors that play significant roles in influencing the T2DM patients, adherence to self-care practices.
Knowledge about the illness is likely to inform patients about specific actions in the diabetes management
process. Thus, the more knowledge patients have about their illness, the more likely they are to comprehend
their illness.
Methods: We have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia. The
study was conducted during the period from October to December 2017. The participants were selected by
random sampling. Sampling included the different geographical areas of the city. The total sample included
120 pupils. All the pupils were approached to obtain the desired sample size. A self-administered questionnaire
about diabetes mellitus and diabetic foot disease was filled by the participants.
In this study age of participants was ranged from 30 to 65 year old, with a mean (SD) of 46.67
(9.218) ,the majority were males (65%) and 73.4% were with basic educational level. The mean of duration of
T2DM among the people was 7.49(SD=7.377) with range=35. Three quarters of participants reported positive
family history of T2DM. Regarding number of family members with history of T2DM, the mean was
1.3(SD=0.975) and range was 5. Participants who reported that their blood sugar was uncontrolled were more
than those who reported that their blood sugar was controlled, (Uncontrolled blood sugar 58.3% and controlled
blood sugar 41.7%).
Conclusion: More attention is needed on primary prevention programs that focus on awareness and
assessment of the diabetic foot disease, and the danger of complications of T2DM and its risk factors.
Keywords: self-awareness, perception, diabetic foot, type 2 diabetes mellitus, Tabuk.

and adherence to self-care practices. Knowledge
More than 350 million people worldwide were
about the illness is likely to inform patients about
known to have diabetes mellitus (DM) in 2013 and
specific actions in the diabetes management process.
an estimated 592 million are expected to have the
Thus, the more patient's knowledge have about their
disease by 2035. Most of these people are between
illness, the more likely they are comprehend their
40 and 59 years of age, and live in low- and middle-
illness and take up self-care behaviors such as diet,
income countries (LMICs)(1,2). It is also estimated
exercise and blood sugar testing among others.
that 50% of people with DM are undiagnosed. The
Diabetes health literacy which is an indication of
World Health Organization (WHO) estimated that
knowledge has been shown to affect self-care
DM will be the seventh leading cause of death in the
practices among persons living with diabetes(8). In
next 15 years (1). Effective self-management of type-
their study, van der Heide et al. (8). examined the
2 diabetes mellitus (T2DM) is crucial to reduce the
mediating role of diabetes knowledge on the
risk of diabetes-specific complications, such as
relationship between diabetes health literacy and
hypertension, amputation, nephropathy, neuropathy,
self-care practices found that lower health literacy
retinopathy, cardiovascular disease, impotence, and
was significantly associated with less diabetes
skin lesions(3,4). Self-management activities included
knowledge, higher glycated hemoglobin (HbA1c)
adherence to diet and nutrition advice, physical
level, less self-control of glucose level and less
activity, taking mediations as prescribed and weight
physical activity. The same study also found that
and stress management (5,6). Evidence suggested
patients with more diabetes knowledge were less
that there is poor adherence to self-care practices
likely to smoke and more likely to control glucose
among diabetes patients globally(7). Thus, it has
levels and that diabetes knowledge mediated the
become necessary to identity factors that play
association between health literacy and glucose self-
significant roles in influencing the T2DM patients
control and between health literacy and smoking(8).
Received: 14/12/2017 DOI: 10.12816/0044356
Accepted: 24/12/2017

Full Paper (vol.706 paper# 23)

c:\work\Jor\vol706_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1030-1034

Evaluation of Knowledge about Risk Factors of Heart Disease in
Tabuk City between Adult Population
Khalid Awd Albalawi, Saleh Hammad Alhawiti
Faculty of Medicine, University of Tabuk, Tabuk/ KSA
Corresponding Author: Khalid Awd Albalawi, Email: k7.a@outlook.com, Telephone: (+966) 599566686

According to World Health Organization (WHO), heart disease especially coronary heart
disease is the leading cause of death globally and one of the major health burdens worldwide. A report
released by the Media and Health Awareness Information Center at the Ministry of Health (MOH) in Saudi
Arabia, pointed out that, cardiovascular diseases (CVD), including heart attacks and strokes, are the cause of
42 percent of the Kingdom's non-communicable diseases deaths in 2010. Vascular injury accumulates in
adolescence, making it necessary for primary preventive measures to be taken from childhood. Therefore,
there is increasing emphasis on preventing atherosclerosis by modifying risk factors, such as healthy diet,
exercise and avoidance of smoking.
Methods: We have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia.
The study was conducted during the period from May to September 2017. The participants were selected by
random sampling. Sampling was stratified for the different geographical areas of the city. The total sample
obtained was 460. All the pupils were approached to obtain the desired sample size. A self-administered
questionnaire about heart disease risk factors knowledge and awareness was filled by participants.
Results: the majority of participants showed right answers and were aware about some of the risk factors of
heart disease. The majority agreed to the following statements: (Being overweight increases a person's risk
for heart disease-96.7%), (Smoking is a risk factor for heart disease-92.4%), (High cholesterol is a risk factor
for developing heart disease-92.4%) and (High blood pressure is a risk factor for heart disease-86.5%).
Conclusion: more attention is needed on primary prevention programs that focus on diet, exercise and the
danger of heart disease and its risk factors should be emphasized.
heart disease knowledge, risk factors, awareness, diet.


Cardiovascular diseases (CVDs) are group
boundaries. It is estimated that far from being
of disorders of heart and blood vessels. According
confined to the developed countries, cardiovascular
to WHO, heart disease especially coronary heart
disease is the leading cause of death in developing
disease is the leading cause of death globally and
countries. 80% of CVD death is contributed by
one of the major health burdens worldwide (1).
countries with low and middle income. People in
For over 80 years, heart disease had been
low- and middle-income countries often do not
the leading cause of mortality for both men and
have the benefit of integrated primary health care
women of all ages and all races in the United
programmed for early detection and treatment of
States. Coronary heart disease (CHD) is the most
people with risk factors compared to people in
common type of heart disease, killing over 370,000
high-income countries. People in low- and middle-
people annually in the United States(2).
income countries who suffer from CVDs have less
A report released by the Media and Health
access to effective and equitable health care
Awareness Information Center at the Ministry of
services which respond to their needs. As a result,
Health (MOH) in Saudi Arabia, pointed out that,
many people in low- and middle-income countries
cardiovascular diseases, including heart attacks and
are detected late in the course of the disease and
strokes, are the cause of 42 percent of the
die younger from CVDs, often in their most
Kingdom's non-communicable diseases deaths in
productive years(1). Some people are at greater risk
2010. The report also noted that the number of
of cardiovascular disease than others. According to
patients with cardiac diseases in the primary health
centers mounts to 167499 people of both males and
hypertension, diabetes, dyslipidemia, obesity,
females. The report underscored that the heart
smoking, physical activity, poor diet and alcohol
attacks and strokes are usually acute events and are
consumption are the most common risk factors for
mainly caused by a blockage that prevents blood
myocardial infarction (heart attack) and strokes
from flowing to the heart or brain. The most
worldwide (2,3).
common reason for this is a build-up of fatty
Major Factors linked to an increased risk
deposits on the inner walls of the blood vessels that
of CVD are grouped into two categories, non-
supply the heart or brain (3). WHO noted that CVD
modifiable and modifiable risk factors. Non-
has no geographic, socioeconomic or sex
modifiable risk factors are factors that are outside
Received: 14/12/2017 DOI: 10.12816/0044357
Accepted: 24/12/2017

Full Paper (vol.706 paper# 24)

c:\work\Jor\vol706_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1035-1038
Prevalence of High Risk Group of Obstructive Sleep Apnea
Among Western Region Population in Saudi Arabia
Mohammed Abdullah Assiri (1), Habibullah Ammar Hussain M (2), Abdulaziz Saud Aljuaid (1),
Saud Mohammed Aleisa (1), Mohammed Ateih Alsofyani (1), Mamdouh Alshareef (3)
1. College of Medicine, Taif University, 2. King Abdullah Medical City in Makkah,
3. Alhada Military Hospital in Taif
Corresponding author: mohammed abdullah assiri, Phone number: +966507546239,E-mail : assiri-x-07@hotmail.com

Obstructive sleep apnea is a chronic morbid condition characterized by frequent attacks of
upper airway collapse during sleep leading to interrupted sleep cycle and daytime fatigue.
Objectives: Assessment of the most affected group of adults by obstructive sleep apnea disorder in western
area of Saudi Arabia and help them to get a good quality of life.
Methods: Cross sectional study involving 214 adults with age between 18 and 80 years old in the western
area of Kingdom of Saudi Arabia. Results: There was no relationship between specific genders with high risk
of OSA, while there was strong relationship between participants from male gender with low risk of OSA.
Also, there was no relationship between age and high risk of having OSA among our participants. In addition,
there is no relationship between age and low risk of having OSA among our participants. There was a
relationship between overweight participants from both gender and high risk of having OSA, while there was
relationship between underweight participants from both gender and low risk of having OSA.
Conclusion: Our study showed that around 28% of populations are in high risk group of having OSA. Also,
sleep apnea in older patients is less severe than sleep apnea in the young.
Keywords: High risk, OSA, low risk, gender, age.

special questionnaire form (berlin questionnaire) to
Obstructive sleep apnea (OSA) is a chronic
the community which was included. Questions
condition characterized by frequent episodes of

upper airway collapse during sleep. It affects
about the obstructive sleep apnea based on the
nocturnal sleep quality resulting in sleeplessness
literature review and its recommendations. High
and in turn daytime fatigue which is widely
risk was considered when there are 2 or more
acknowledged (1).
categories of the score are positive, while low risk
OSA prevalence ranged from 3.7% to 97.3%.
was considered if there is only 1 or no categories of
Male gender, older age, a higher BMI and waist to
the score is positive. Survey items addressed the
hip ratio, greater neck circumference, arterial
presence and frequency of snoring behavior, wake
hypertension, smoking, snoring and daytime sleep
and sleep or fatigue times, and history of obesity or
were associated with OSA (2)

. Strong cohort studies
hypertension. Patients with persistent and frequent
indicated that undiagnosed obstructive sleep apnea,
symptoms in any two of these three domains were
with or without symptoms, is independently
considered to be at high risk for sleep apnea. We
included male and female between 18 to 80 years
hypertension, cardiovascular disease, stroke,
old and live in western area of Saudi Arabia and
daytime sleep, motor vehicle accidents, and
excluded who were under 18 years old or above 80
diminished quality of life. Strategies to decrease the
years old and don't live in western area of Saudi
high prevalence and associated morbidity of
Arabia. Statistical analysis was performed using the
obstructive sleep apnea are critically needed (4).
(SPSS softwear v20). The study was done after
Aim of our study is to discover the most
approval of ethical board of King Abdulaziz
affected group of adults by obstructive sleep apnea
disorder in western area of Saudi Arabia where

there was no previous studies done in such place.

Number of our participants was 214
participants, 117 participants (54.7 %) of them were
Cross sectional study with 214 adults with age
males and 97 participants (45.3 %) were females
between 18 and 80 years old. The study was
(table 1). 137 of our participants from age of 18-30,
approved by the King Faisal Hospital in Taif, Saudi
16 participants from age of 31-40, 11 participants
Arabia. The data were collected in the western area
from age of 41-50, 22 participants from age of 51-
of Kingdom of Saudi Arabia, by distributing a
60, 20 participants from age of 61-70, 7 participants
Received: 15/12/2017 DOI:

Accepted: 25/12/2017

Full Paper (vol.706 paper# 25)

c:\work\Jor\vol706_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1039-1046

Prehospital Tracheal Intubation versus Emergency Department
Intubation for Trauma Patients
Ali Mohammed B Alzahrani 1, Abdullah Musari Alanazi 2 , Mohammed Ali Mohammed Alsaghirat
3 , Khalid Munawir Alotaibi 4 , Yazeed Khaled A Binmahfoz 5 , Fahad Mohammed Altowairqi 6 ,
Mansour Manwi A Alanazi 7 , Turki Khalid Alotaibi 4 , Waddah Ahmed A Alsharif 8 , Abdulhadi
Mohammed A Alqahtani 9 , Sharaf Hassan S Muathin 10 , Sultan Jaber M Alfaifi 11
1- King Fahad Hospitan In Albaha, 2- Prince Abdulaziz Bin Musaed Hospital-, 3- Imam Abdulrahman Bin
Faisal University , 4- King Saud University In Riyadh , 5- Jeddah University , 6- The Royal Saudi Land
Forces , 7- PHC in Haferalbatin , 8- King Abdulaziz University , 9- King Abdulaziz Hospital, Makkah ,
10- Taif University , 11- Prince Mohammed Bin Nasser Hospital-Jazan

Patients with severe traumatic brain injury (TBI) are at high risk for airway obstruction and
hypoxia at the accident scene, and routine prehospital endotracheal intubation has been widely advocated.
Aim of the Study: to evaluate and compare the outcome and mortality rates of trauma patients undergoing
Prehospital Tracheal Intubationversus those undergoing Emergency Department Intubation.
Methods: A literature search was carried out on MEDLINE (including MEDLINE in-process), CINAHL,
Embase and the Cochrane Library (from 1990 to October 2017). Databases using "Prehospital Tracheal Intubation",
"Emergency Department Intubation ", "Adults trauma", and "mortality" as a MeSH heading and as text word.
High yield journals were also had searched.
Results: Eleven studies enrolling 17317 patients were included, out of which 4545 underwent PTI while 12772
underwent EDI. Median mortality rate in patients undergoing pre-hospital intubation was 52.12% (7.8­90.16%),
compared to 27.98% (6.25­41.56%) in patients undergoing intubation in the emergency department. The overall
quality of evidence was very low. Six of the eleven studies found a significantly higher mortality rate after pre-
hospital intubation whilst five found no significant differences.
Conclusion: Study outcome suggests that EDI was superior to PHI. Nevertheless, prehospital intubation was a
marker for more severely ill patients who would have had higher mortality thus, the suggestion of the
association between pre-hospital intubation and a higher mortality rate does not essentially oppose the
importance of the intervention, but rather a need for further
investigation of the possible causes for this
Keywords: Prehospital Tracheal Intubation, Emergency medical services, Airway management, Rapid sequence
induction, mortality, Emergency Department, Intubation, Trauma.

realm of on-scene emergency response, particularly
Airway compromise is declared to be a cause of
in the arena of air medical services.
poor outcomes and mortality in trauma and cardiac

arrest patients for many years (1).
After arriving into a hospital, the critical and
While physician-staffed ambulance services had
complex intervention of emergency tracheal
been established worldwide for more than a century,
intubation (ETI) is usually provided by
the late 20th century evolution of prehospital care
appropriately trained physicians. Most of these
was highlighted by documentation of life-saving
physicians are trained anaesthesiologists or
outcomes in those first modern EMS programs and
emergency physicians trained in anaesthesiology(3).
their use of invasive ,,advanced life support (ALS)

procedures including prehospital endotracheal
Tracheal intubation (TI) is a critical intervention
intubation (ETI) and intravascular (IV) cannulation
regularly conducted by emergency medical service
for drug administration (2). These life-saving reports
(EMS) providers to secure the airway of severely ill or
helped to propel the widespread adoption of EMS
injured patients worldwide. This activity is based on
systems and the concomitant introduction of
th assumption that, in keeping with in-hospital
practice, a compromised airway should be secured as
medical technicians called ,,paramedics (2).
early as possible to ensure adequate ventilation and
Eventually nursing personnel also ventured into the
Received: 15/12/2017 DOI: 10.12816/0044359
Accepted: 25/12/2017

Full Paper (vol.706 paper# 26)

c:\work\Jor\vol706_27 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1047-1055

The Correlation between Vitamin D and Cognition: A Review
Wesal Ibrahim H. Alzain 1 , Meshal Mohammed Altowairqi 2 , Duaa Khalid M Alalawi 3 ,
Norah Mohammed A Althubaiti 4 , Siyadah Anwar Abduljawad 5 , Sami Muslim Alloqmani 6 ,
Amani Hussain Alshawaf 7 , Abdullah Saleh Alqahtani 8 , Ahmad Ibrahim M Albridi 9 ,
Abdullah Jameel Motahar 8 , Mohamad Fahad M Alreshoudi 10 , Laila Mossa Mahdi11
1- Jarwal Phcc Makkah Almukaramah , 2- Prince Sultan Medical Military City ,
3-Warsaw Medical University , 4- King Abdulaziz University , 5- Ibn Sina College ,
6- PHC at Madinah , 7- PHC at Al-Ahsa , 8-Umm Alqura'a University ,
9- King Khalid University , 10- Qassim University , 11- Aseer Central Hospital

During the last 25 years, vitamin D -being a member of the superfamily of nuclear steroid
transcription regulators - has emerged as a serious candidate in nervous system development and function and a
therapeutic tool in a number of neurological pathologies. More recently, experimental and pre-clinical data
suggest a link between vitamin D status and cognitive function. Human studies strongly support a correlation
between low levels of circulating 25-hydroxyvitamin D (25(OH)D) and cognitive impairment or dementia in
aging populations. In parallel, animal studies show that supplementation with vitamin D is protective against
biological processes associated with Alzheimer's disease (AD) and enhances learning and memory performance
in various animal models of aging and AD. More recently epidemiological associations have been made
between low vitamin D and psychiatric disorders not typically associated with abnormalities in brain
development such as depression and Alzheimer's disease
Aim of the Study: was to review the recent literature to investigate the correlation between vitamin D status
and neurocognitive function.
Methods: We searched the medical literature to retrieve studies for the review to 30 November 2017. electronic
search in the scientific database from 1965 to 2017­ (Medline, Embase, AMED, Psych INFO, the Cochrane
Library websites were searched for English Publications were obtained from 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: Accumulating evidence in the current literature indicate that vitamin D deficiency is highly
prevalent among patients with cognitive impairment, and that low vitamin D status may negatively impact
cognition and that hypovitaminosis D is usually associated with increased risk of developing AD and dementia.
Nevertheless, while vitamin D supplementation is safe for those with cognitive impairment, there is no solid proof
that they will see significant improvement in their symptoms.
Keywords: cognitive function, vitamin D, Dementia, Alzheimer's disease, Hypovitaminosis D, VDR, 25-
hydroxyvitamin D (25(OH)D).

neuroprotective potential and antioxidant effects
Hypovitaminosis D- in other words Vitamin D
[2]. Studies on VDR knockout mice have
deficiency- lessens vitamin D activity in a variety
demonstrated that hypovitaminosis D may play a
of organs, including the central nervous system.
role in accelerated ageing, behavioural, social,
Low 25-hydroxyvitamin D [25(OH)D] levels are
motor and sensory deficits [3]; all of which can
prevalent in older individuals, and adults with
contribute to cognitive decline.
cognitive difficulties have been shown to have
The consolidation of information in the brain is the
hypovitaminosis D [1]. There is a biologically
basis for learning and memory. Various threads of
plausible link between vitamin D and cognitive
information can be stored in many parts of the brain,
function. The vitamin D receptor (VDR), vitamin
such as the cortex and the hippocampus. The
D metabolites and enzymes required for vitamin D
hippocampus, which is located in the middle
activation have been found in the brain and central
temporal lobe, plays an important role in mammalian
nervous system. Additionally, experimental studies
spatial learning and memory consolidation[4]. Low
have demonstrated that active vitamin D may
levels of vitamin D in elderly people are associated
influence brain and neuron development, and have
with age-related disorders, including cancer,

metabolic disorders, and vascular diseases [5].
Received: 11/12/2017 DOI: 10.12816/0044361
Accepted: 21/12/2017

Full Paper (vol.706 paper# 27)

c:\work\Jor\vol706_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1056-1061
Misuse of Antibiotics Therapy in General Population of Saudi Arabia
Naif Negikhan AlOtaibi (1), Majed Dakhel Almutairi (1), Youssef Zaid Al-Namshan(2),
Mohammad Abdulrahman Al Dhohayan(3), Rakan Deeb Alotibi(1)
(1) Security Force Hospital, (2) King Saud University, (3) Qassim University
The misuse of antibiotic treatment is an important cause of emerging bacterial resistance.
Taking antibiotics without prescription through self-medication, friends or relative opinions, or pharmacist
advice is a very common behavior in the developing countries.
Methods: The sample was selected from the most important and most populated area in Saudi Arabia
(Riyadh region). The data were collected through self-administered questionnaires for educated participants
and with interviewers for non-educated participants. The participants were selected randomly from
outpatient attendants of hospital and health centers. The data were analyzed using SPSS software program,
with descriptive and inferential statistics. Results: The response rate was 96% with mean age of 32 ± 12.79
years, ranging from 14 ­ 80 years. Male subjects were a little more than females. Most of these subjects were
university students. About 73% were not health staff and approximately 70% of subjects reported that they
had health insurance. Most subjects (65.7%) took the antibiotics based on specialist prescription. For those
who took their drugs without prescription, around 67.2% reported that was because they used it before.
Following doctor's instructions about the time of taking the drug was reported by 80.3% of subjects.
Following doctor's instructions regarding the appropriate dose was reported by 88% while, taking all the
prescribed doses was only reported by 56% of the subjects. Significant association was found between health
insurance and the way the subjects take their drug. Also, significant associations were found between
education and income with following the doctor's instruction regarding taking all doses.
Conclusion: Misuse of antibiotic is still higher. There is extremely need for public educational programs in
addition to application of the laws.
Keywords: Education, Antibiotics, Misuse, Community, Saudi Arabia


In UAE, about two thirds of antibiotics sale
Antibiotics are the most commonly used
on over-the counter (OTC) basis, in Egypt it is
drugs globally and especially in low income
even worse with 86.4% of antibiotics are sold
countries where infectious diseases are prevalent
OTC (9, 10). In Saudi Arabia, despite the continuous
health problems. The misuse of antibiotic
educational efforts, number of antibiotics
treatment is an important cause of emerging
dispensing OTC are elevated in the last years.
bacterial resistance (1). Ecological studies have
Although, the Saudis authorities prohibited sale of
found bacterial resistance strongly related to the
antibiotics without prescription since 1972, this
magnitude of antibiotics sale. The common
malpractice is increasing. This study aims to
practices of antibiotics misuse include incomplete
evaluate the misuse of antibiotics among general
regime of treatment, non-compliance with
population in Saudi Arabia.
instructions of antibiotic use, and taking

antibiotics without physician consultation (2).
Taking antibiotics without prescription through
This is a cross-sectional study included 534
self-medication, friends or relative opinions, or
study participants, according to the sample size
pharmacist advice is a very common behavior in
calculation at 95% confidence interval, 0.50
the developing countries (2).
expected proportion, and 0.07 for standard error.
Self-medication is a prevalent practice in
The sample was selected from the capital city area
countries such as Sudan, Ethiopia, Pakistan,
in Saudi Arabia (Riyadh region). and then the
Yemen, Saudi Arabia, Jordan, and Brazil (3-8). In
sample was stratified according to the size of
addition, some developed countries in name
population in each area. The data were collected
Spain, United States, and Russia reported high
through self-administered questionnaires for
rates of inappropriate antibiotic use. This
educated participants and with interviewers for
worldwide occurrence of this problem requires
non-educated participants. The participants were
large scale studies that investigate roots, causes
selected randomly from outpatient attendants of
and consequences of antibiotic misuse. One of the
hospital and health centers. The questionnaire had
important causes of this problem is lack of health
two sections, section A for demographic data and
insurance which make patients try to avoid the
section B for data about malpractices in antibiotic
physicians' bills and conduct self-medication (6).
use. Written consents were obtained from study
Received: 11/12/2017 DOI: 10.12816/0044362
Accepted: 21/12/2017

Full Paper (vol.706 paper# 28)

c:\work\Jor\vol706_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1062-1065

Association Between Stroke and Hypertension and Deep Vein
Thrombosis in Northern Saudi Arabia: Community-Based Study
Ahmad Soud Alzayed1*, Hussain Gadelkarim Ahmed2, Faisal Soud Alzayed1, Kareem Saleh
Alshammari1, Aqeel Jazzaa Alshammari1, Amjad Tallaa Ali Tallaa1, Abdulaziz Farhan Alharbi1,
Mohannad Yousef Aljarallah1, Ziyad Ali Alosayfir1
1College of Medicine, University of Hail, Hail, 2College of Medicine, University of Hail, Molecular
Diagnostics and Personalized Therapeutics Unit, University of Hail, Hail, Saudi Arabia
*Corresponding author: Ahmad Soud Alzayed. E-mail: Dr.alzayed99@gmail.com Phone number:+966550990686

Deep venous thrombosis (DVT) is a serious complication of various medical conditions
including acute stroke.
Objectives: We aimed to analyze the association between stroke toward hypertension (HP) and deep vein
thrombosis (DVT) in northern Saudi palpitations.
Methods: Cross-sectional study was performed, all incident stroke events during followup were identified by
searching the hospital discharge diagnosis registry, and previous patient's medical records. Also, we conducted
a questionnaire survey among population of North Saudi Arabia including 15 cities.
Results: Our study showed that HP, and DVT which is definitely associated with stroke occurs only in
approximately 5% of patients and significantly affects mortality among population from northern Saudi.
Conclusion: Severe HP events with no stroke incidence is associated with increased risk of DVT especially in
Male and age group above 55 years. Therefore, it may be reasonable to provide this group of patients with
additional care and proper DVT prophylaxis in order to minimize the risk of stroke. Also, those patients with
HP should be managed and followed regularly especially elderly patients who are at risk.
Keywords: hypertension, Stroke, Deep vein thrombosis, Soudi Arabia.


Hypertension (HP) is one of the major causes of
suggested. Guidelines advise for intravenous (i.v.)
condition burden all over the world [1]. In 2000, it
anti-hypertension medicine to streamline treatment,
was estimated that about 1 billion cases endured
as well as for comfort and also effectiveness [3, 4].
hypertension as well as by 2025, the number is
Nevertheless, the optimal technique for HP-lowering
predicted to increase to 1.56 billion [2]. It is among
management continues to be contradictory [7].
the most important risk aspects for cardiovascular
Furthermore, a high BP is beneficial to preserve
disease, stroke, coronary artery disease, as well as
blood circulation in the ischemic brain. Nonetheless,
sudden death [3]. Excessive weight, cigarette
it might also be damaging when it comes to brain
smoking and alcohol intake have actually been
edema and hemorrhagic stroke [6]. We aimed to
reported to play vital duties in the threat of
analyze the association between stroke toward
uncontrolled and unattended high blood pressure [4,
hypertension (HP) and deep vein thrombosis (DVT)
5]. Deep capillary apoplexy (DVT) is a systemic
in northern Saudi populations.
disease with an incidence of 67 per 100,000 of

situations yearly [6]. DVT, including lung blood clot,
is a serious complication of various clinical stroke
Cross-sectional study was performed, all incident
conditions which is formed mainly within 2 weeks'
stroke events during followup were identified by
post-stroke [7]. Its occurrence in debilitated post-
searching the hospital discharge diagnosis registry,
stroke patients ranges from 10 to 75%, depending
and previous patient's medical records. Also, we
upon the diagnostic technique and also time of
conducted questionnaire survey among population of
assessment [2, 7]. According to the literary works, the
North Saudi Arabia including 15 cities as shown in
major threat elements of post-stroke DVT are older
table (1). Participants who developed stroke during
age and hypertensive patients [6, 7].
the specific period contributed in our survey, and
HP was observed in over 60% of the stroke
included the date to date of diagnosis of the stroke
patients [4]. Hence, BP management is highly
and other concerned diseases (hypertension, and
Received: 12/12/2017 DOI: 10.12816/0044363
Accepted: 22/12/2017

Full Paper (vol.706 paper# 29)

c:\work\Jor\vol706_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (6), Page 1066-1071

The Patterns of Surgically Treated Thyroid Disease in Central
Rural Region of Saudi Arabia
Abdulhkam Aljarbou*, Anthony Morgan, Fawaz Alshaalan, Dhafer Alshehri,
Mohammed Alshathri, Khalaf Alsayyali
Department Of General Surgery, Prince Sattam Bin Abdulaziz University Al Kharj City ,Saudi Arabia
Corresponding Author: Aljarbou Abdulhkam,Emil: mr.hkoome@hotmail.com,Phone number: 00966565444272

It is well recognized that incidence of thyroid disease is increasing in Saudi Arabia and varies in
geographical areas of Saudi Arabia. This study was aiming to evaluate the patterns of thyroid pathology in Al
Kharj region, which is a rural agricultural area in central Saudi Arabia with relatively large (3.1%) population.
Methods: The retrospective study was designed covering period from 2012 to 2016, which include only patients,
who received surgical treatment for the various thyroid pathologies. All data was collected from Department of
Surgery at King Khaled Hospital (KKH), which is the university hospital, serving over 600,000 population of Al
Kharj region. 92 thyroidectomies performed for various thyroid disorders where analyzed.
Result: The incidence of thyroid disease for females in Al Kharj region was estimated as 2.7/100.000 of
population per year comparing to males of 0.4/100.000 respectively. Female to male ratio of 6.7:1 was observed
in relation to the overall thyroid pathologies. The mean age of all studied cases was 41.3 years ranging from 19 to
77 years. The majority of the thyroid diseases was in the age group 20-50 years (79.3%). Cancerous lesions were
found in 35 cases (38%) and presented mainly as papillary or follicular carcinomas with the female to male ratio
of 10.5:1. The prevalence of thyroid cancer in Al Kharj region in current study was 1.1/100.000 of population per
year for females and 0.1/ 100.000 of population per year for males respectively.
Conclusion: This study showed that in central rural province of Saudi Arabia females are dominantly affected by
thyroid pathologies. The female to male ratio requiring surgical intervention was higher in Al Kharj region
compared to the other Saudi Arabian areas. Incidence of thyroid pathology and prevalence for thyroid cancer was
significantly higher in females compare to male population.
Keywords: Thyroid disease, Thyroid cancer, Saudi Arabia research, Incidence and prevalence

currently is the most frequent malignancy in
The incidence and prevalence of thyroid disease
endocrine disorders, which accounts for more than
globally continue to increase substantially and
90% of malignant endocrine tumors. In 2010 thyroid
recently became a common clinical issue that
cancer ranked as the third most prevalent cancer,
associated with aging, where two-thirds of the people
which affect Saudi Arabian adult population after
who are diagnosed with thyroid cancer were between
breast cancer and colorectal cancer. According to the
20 to 55 years old. In the United States alone,
resent data from the National Cancer Institute,
incidence of thyroid diseases rose 12 times for
approximately 1.2 % of population will be diagnosed
women and 1.5 times for men over the last 60 years
with thyroid cancer at some point of a lifetime.
[1,2]. Risk factors, such as low iodine diet, exposure to
Recent reports demonstrated that in Saudi Arabia,
ionizing radiation, hereditary factor and obesity
thyroid carcinomas w a s accounted for 5% to 6.1%
increase the incidence of developing thyroid disease
of all newly clinically diagnosed cancers cases
and thyroid cancer. However, the majority of people,
and are ranked second in females and fourth in males
who are diagnosed with thyroid cancer, have no
with female to male ratio of 3.46:1.
apparent risk factors and the remaining patients may
In the Cancer Incidence Report, Ministry of Health
have one or two risk factors [3]. It is well recognized
of Saudi Arabia and Saudi Cancer Registry 2010, the
that nodular thyroid disease is frequently present in
thyroid cancer ranked the third most prevalent cancer
mountain areas of Saudi Arabia, which is explained
among Saudi adults, after breast and colorectal
by the iodine deficiency in these regions. However,
cancer [5]. As the first line of thyroid pathology
the risk factors in other areas are poorly identified in
diagnosis, thyroid ultrasound is commonly used as a
literature [4]. It is well established that thyroid cancer
sensitive and noninvasive diagnostic imaging for
Received: 12/12/2017 DOI: 10.12816/0044365
Accepted: 22/12/2017

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