c:\work\Jor\vol707_1 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1072-1082

Role of CT and MRI in Diagnosis of Pericardial Diseases
Amr Ibrahim Ali Mahmoud, Laila Ahmad Abdurrahman,
Yasser Ibrahim Abdel Khalek
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
Corresponding author: Amr Ibrahim Ali Mahmoud, email: dr.amribrahim93@gmail.com

Background: pericardial diseases are important causes of morbidity and mortality in cardiovascular diseases.
CT and MRI are more than adjuncts to echocardiography in pericardial diseases assessment, as they provide an
excellent pericardial anatomy delineation and precise pericardial lesions evaluation including; effusion,
constrictive pericarditis, thickening, masses and congenital anomalies. Ideal management needs the proper
imaging modality choosing ability. Aim of the Study: this study aimed to evaluate the role of CT and MRI
versus echocardiography in the diagnosis of pericardial diseases and to show the limitations of each modality.
Conclusion: tissue characterization with CMR is superior to cardiac CT and echocardiography. CMR can
differentiate tumor from thrombus and is often helpful to assess the perfusion of a pericardial mass with the use of
gadolinium contrast. The final diagnosis depends on typical pathologic features.
Keywords: pericardial diseases, CT, MRI.


The pericardium represents a simple, two-layered,
potentially hemodynamic catheterization, depending
fibroelastic sac that surrounds the heart and provides
on the nature and severity of the symptoms. While
lubrication and protection. Normally, it is a thin-
these tools have a broad and well-established role in
walled structure (<3 mm) with minimal pericardial
the diagnosis of pericardial disease, newer modalities,
fluid (<50 ml). The normal pericardium is fairly
such as cardiac computed tomography (CT) and
distensible, precluding excessive constraint of the
cardiovascular magnetic resonance imaging (CMR)
ventricles (1). The pericardium has been described as
are important methods for aiding in diagnostic
an intracardiac pressure modulator, limiting acute
evaluation (6). Echocardiography is the method of
distention of any cardiac chamber (2). Pericardial
choice for evaluating most pericardial diseases. When
diseases are important causes of morbidity and
competently performed in patients with good acoustic
mortality in patients with cardiovascular disease.
windows, echocardiography accurately detects all
Inflammatory diseases of the pericardium constitute a
pericardial effusions and provides clinically relevant
spectrum ranging from acute pericarditis to chronic
information about their size and hemodynamic
constrictive pericarditis. Other important entities that
importance. The technique is less reliable than MRI
involve the pericardium include benign and malignant
pericardial masses, pericardial cysts, diverticula, as
thickening/constriction and calcification as well as
well as congenital absence of the pericardium (3).
small loculated effusions, but is still extremely useful
Although the underlying etiology of pericardial
in these conditions (7).
disease varies, the typical response of the pericardium
In the evaluation of pericardial disease, CT and MRI
is relatively nonspecific, with production of
traditionally have been used as adjuncts to
pericardial fluid. A wide range of pericardial diseases
echocardiography. However, CT and MRI are
may occur, including acute or chronic inflammation,
particularly useful as sensitive and noninvasive
fibrosis or effusion (4). The pericardium may be
methods for evaluating loculated or hemorrhagic
secondarily involved by a large group of systemic
pericardial effusion, constrictive pericarditis, and
diseases, such as infective, autoimmune and
pericardial masses. Both CT and MRI provide
neoplastic processes. Moreover, iatrogenic causes for
excellent delineation of the pericardial anatomy and
example, after cardiac surgery or radiation therapy
can aid in the precise localization and characterization
represent an important cause of pericardial related
of various pericardial lesions, including effusion,
morbidity and mortality (5). Clinical diagnosis with a
constrictive pericarditis, pericardial thickening,
detailed examination is often complemented by ECG,
pericardial masses, and congenital anomalies. Both
chest x-ray (CXR) and echocardiography, as well as
modalities provide a larger field of view than does

echocardiography, allowing the examination of the
Received: 25/11/2017 DOI: 10.12816/0044529
Accepted: 05/12/2017

Full Paper (vol.707 paper# 1)

c:\work\Jor\vol707_2 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1083-1089

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


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

mortality from alcoholic cirrhosis in women
Heavy alcohol consumption causes alcoholic
compared with the Danish general population.
liver disease and is a causal factor of many types of
However, there was no further dose­ response
liver injuries and concomitant diseases. It is a true
relationship and no additional risk for drinking a
systemic disease that may damage the digestive
much higher volume than 60 g day-1[3].
tract, the nervous system, the heart and vascular
Abstinence from alcohol may help people with
system, the bone and skeletal muscle system, and
alcoholic disease in improving their prognosis of
the endocrine and immune system, and could lead
survival at any stage of their disease; however, the
to cancer [1].
more advanced the stage, the higher the risk of
Alcohol-related liver disease is linked to the
complications, co-morbidities, and mortality, and
pattern of alcohol consumption [2].
lesser the effect of abstinence. Being abstinent one
90% -100% of heavy drinkers develop fatty
month after diagnosis of early cirrhosis will
liver disease.
improve the chance of a seven-year life expectancy
10% -35% of heavy drinkers develop
by 1.6 times [4].
alcoholic hepatitis.
Liver transplantation is the only radical method
8%- 20% of heavy drinkers develop alcoholic
that may change the prognosis of a person with
alcoholic liver disease; however, besides the
In 2004, a Danish group [3] concluded, that
difficulties of finding a suitable liver transplant
there was a threshold seen at a consumption level of
organ, there are many other factors that may
greater than five drinks (60 g of pure alcohol) on
influence a person's survival [5].
average per day. People drinking that heavily had
The liver is the main site of alcohol metabolism
an increase in the rate of mortality by 27 times from
acting through two hepatic enzymes, alcohol
alcoholic cirrhosis in men and a 35-fold increased
dehydrogenase and cytochrome P-450 (CYP) 2E1.
Received: 13/12/2017 DOI: 10.12816/0044530
Accepted: 23/12/2017

Full Paper (vol.707 paper# 2)

c:\work\Jor\vol707_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1090-1092

Awareness of Prostate Cancer, Screening and Methods of
Managements in a Hospital in Riyadh, Saudi Arabia
Ahmed Mousa Almuhanna1, Sulaiman Alshammari1, Hussain Khaled Alsalman1,
Hassan Albeladi1, Ali Alsubaie1, Waleed A. Abueissa1, Fatimah Alkhawaja2,
Hussain Ali Busaleh*3
1College of Medicine, King Saud University, Riyadh ,2Alfaisal university, Alriyadh,
3University of Science and Technology
Corresponding Author: Ahmed Mousa Almuhanna, E-mail: a.almuhanna4@hotmail.com

: screening for prostate cancer (PCa) is surrounded by controversies regarding the benefits, risks
and uncertainties of undergoing the screening. Current practices of prostate cancer involve measuring the level
of PSA and digital rectal examination. This study aimed to measure the knowledge and awareness of
undergoing a prostate cancer screening and the available treatment options amongst the participants.
Method: a questionnaire-based quantitative cross-sectional study which focuses on determining the
knowledge of prostate cancer screening and management in a hospital in Riyadh.
Results: three hundred and twenty-three participants filled the surveys (100% males), more than 80% of all
ages had heard about prostate cancer and that it is a disease of the male. A higher level of education is
significantly associated with the level of awareness (P-value <0.001). More educated participants selected 40
years old as the appropriate age for PCa screening (P-value 0.009) and radiotherapy as the mode of treatment
(P-value 0.01). 43.34% saw PCa as a cause of death and 41.4% saw it associated with smoking. Only 17.84%
undergo continuous PCa screening most of them in 50-60 age group with "reassurance" as the main motivator.
37.8% of the participants did not know the symptoms of PCa and around 25% selected pain in micturition,
difficult frequent micturition and bone pain as symptoms of PCa.
Conclusion: although prostate cancer is known amongst the majority of the participants, only a minority of
them has knowledge of the symptoms and undergoes regular screening.
Keywords: Carcinoma, Prostate cancer, PCa, awareness survey, prostate.


Median age at diagnosis was 73 years(5). This
It is common knowledge that prostate
study aims to determine the awareness and attitude
cancer (PCa) is a major illness in the world.
of prostate cancer screening and management.
Screening for prostate cancer is performed through

digital rectal examination (DRE) and prostate
specific antigen test (PSA). The benefits of this is
Study Design
controversial with the European Randomized
A quantitative cross-sectional study which
Study of Screening for Prostate Cancer (1) finding a
focused on determining the knowledge of prostate
significant reduction of PCa mortality with PSA
cancer screening and management in Saudi
screening while the US-based Prostate, Lung,
Arabia. Data was collected from King Khaled
Colorectal and Ovarian Cancer Screening Trial (2)
University Hospital (Riyadh) using a self-
showed no beneficial reduction in mortality with
administered questionnaire. Data was collected
PSA and DRE(1,2) . However, a living meta-
from 300 participants.
analysis found a small beneficial reduction of

mortality with adequate duration of screening (3).
Study Setting
The American Cancer Society recommends
The target population was males present in
individual with high risk to develop PCa to receive
the waiting area of the outpatient clinics of King
information about the potential benefits, risks and
Khaled University Hospital. Exclusion criteria are;
uncertainties of prostate cancer screening by the
age less than 40 years old, cannot read Arabic,
age of 40 (4). Prostate cancer is the most common
tourists. Participants were consecutively selected
cancer among men and the second most common
and asked to fill out a questionnaire.
cause of death in men worldwide. In Saudi Arabia,
The study was done after approval of
there were 323 cases of prostate cancer among
ethical board of King Saud university.
males in the year 2014 which ranked 4th among
Tool of Data Collection
males. The ASR was 5.5/100,000 among male
A questionnaire written in Arabic was face
population and the highest region was the east at
validated by showing it to consultant of urology in
12.6/100,000 then AL Riyadh at 9.5/100,000.
Received: 13/12/2017 DOI: 10.12816/0044531
Accepted: 23/12/2017

Full Paper (vol.707 paper# 3)

c:\work\Jor\vol707_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1093-1096

Assessment of Knowledge and Attitude and Practice of Family
Towards Physical Activity in Makkah City, 2017
Assaf Nahar J Alsulami1, Essam Abdullah Alghamdi2, Abdullah Ali Alshehri1,
Fahad Saleh A Alsefry3, Shaima Tariq Mansoor3
1-Umm Alqura University, 2- General Surgery Department, Umm-Alqura University,
3-Ibn Sina National College

Physical activity could enhance the personal wellbeing and reduce the risks of many medical
disease around the world
Objectives: Assessing the knowledge and attitude and practice (KAP) of family towards physical activity in
Makkah city in Kingdom of Saudi Arabia (KSA).
Methods: This study was based on cross-sectional questionnaire sheet study conducted in Makkah City from
September to November 2017among 400families from different parts of Makkah City.
Results: Most of the subjects had appropriable knowledge about the importance of physical activity and risk
factors of physical inactivity. The attitude of the subjects was positive among most of them toward regular
physical exercise, enhancing their family to practice physical activity and practicing physical activity with
their family. The level of practice was insufficient among most of the respondents regarding sports practice
with their family and going for a long walk with their family. But the majority taught their children about the
importance of physical activity and 50.5% let their children practice swimming and light physical activity.
Conclusion: Although most of the subjects had good knowledge and attitude toward physical activity, the
practice pattern was insufficient among most of them. There is a need for enhancing the physical activities
among families in KSA and assessing the prevalence of chronic diseases among physically inactive subjects.
Keywords: Knowledge, Attitude, Practice, Physical Activity, Family, Makkah City, KSA.


its pattern in different areas (10, 11). The present
Physical activity could enhance the
study aimed at assessing towards family towards
personal wellbeing and reduce the risks of many
physical activity in MaKKah city in Kingdom of
medical disease around the world (1). According to
Saudi Arabia (KSA).
the WHO statistics, physical inactivity resulted in

about19 million disability and1.9 million deaths.
Also, it could induce major chronic diseases
Study design
including diabetes, ischemic heart disease and
This study was based on cross-sectional
many types of cancers including breast and colon
questionnaire sheet study conducted in Makkah
cancer(2). It was rated as the fourth leading cause
City from September to November 2017.
of death with a global mortality rate accounting
Study population and sample size
more than 6% (3). The risks of physical inactivity
The study population were parents from both
were found to be high in developing countries than
genders and have at least one children. Makkah
in developed ones. In KSA, the estimated physical
was divided into 4 regions (east, west, north and
inactivity risks were 44.6 % which was higher
south) and 100 random houses were chosen from
than that in the United Kingdom (37 %) and in the
each part using multi-randomized sampling
United States (35 %)(4).
technique. Thus 400 families were included in the
About 60% of the Saudi population were
study who were interviewed at their houses and
considered physically inactive and 90% of them
asked to answer the questionnaire.
may sit for more than 2 hours consecutively (5). In

KSA, many studies have been conducted to assess
Study tools

the adoption of Saudi subjects to physical activity
There was no available studies that evaluated
in which there were a high prevalence of physical
the physical activity of the family thus the
insufficiency among adults (6, 7). Physical activity
questionnaire was developed after reviewing the
(PA) has many benefits but most of populations
available studies that were conducted to study the
are still inactive. This could be due to many
knowledge about physical activity in KSA. The
barriers including time, society habits and the dry
questionnaire was revised and validated by 3
weather (8, 9). There is a lack of studies conducted
experts then translated into Arabic. The
in KSA to determine the prevalence of PA among
questionnaire included 4 parts divided as
family members. Also, other studies that assess the
demographics, knowledge, attitude and practice of
prevalence of physical activity failed to recognize
the study participants toward physical activity.
Received: 14/12/2017 DOI: 10.12816/0044532
Accepted: 24/12/2017

Full Paper (vol.707 paper# 4)

c:\work\Jor\vol707_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1097-1110

Level of Chemerin and Anti-Müllerian Hormone in Egyptian
Obese Women with Polycystic Ovarian Syndrome
Fahd A. El-Omda1, Ibrahim A. Emara2, Doaa M. Abdel-Latef 3and Rawda H. Zayan 3*
Gynecology and Obstetrics Department, Faculty of Medicine, Al-Azhar University, Egypt1
Biochemistry Department, National Institute of Diabetes and Endocrinology (NIDE), Egypt 2
Biochemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Egypt3
*Corresponding author: Rawda H. Zayan3, E-mail address: rawda7hamed@yahoo.com, Mobile: 00201113611696

Chemerin is a newly discovered adipokine that regulates adipocyte development, metabolic
function as well as immune function. Anti-Müllerian hormone (AMH) is a dimeric glycoprotein that belongs
to the transforming growth factor-beta family.
Aim of the study
: was to evaluate the serum levels of Chemerin and AMH in one trial to show their possible
involvement in the pathogenesis of PCOS and their association with obesity.
Subjects and methods:
This study was performed on eighty subjects divided into 4 groups: Group I: 20 non-
obese control (BMI< 30), Group II: 20 non-obese patient with polycystic ovarian syndrome (BMI< 30),
Group III: 20 obese Control (BMI 30) and Group IV: 20 obese patient with PCOS (BMI 30). Serum levels
of Chemerin and AMH were estimated by ELISA.
Results: Results showed a significant increase in serum levels of Chemerin and AMH in (non-obese and
obese) PCOS groups when compared to their controls. Results showed also a significant increase in the serum
level of Chemerin in obese PCOS group when compared to non-obese PCOS group. While a significant
decrease in serum level of AMH in obese PCOS group when compared to non-obese PCOS group. There were
a significant positive correlation between Chemerin and AMH in PCOS groups.
Conclusion: Chemerin together with AMH may be used as a biomarker for early detection of PCO and
Clinical parameters as Infertility and Hyper and rogenism in women with PCOS.
Keywords: Polycystic ovary syndrome, Anti-Müllerian hormone, Chemerin.


Polycystic ovary syndrome (PCOS) is a
of women with PCOS. The cause of insulin
complex condition characterized by elevated
resistance is likewise complex and multifactorial
androgen levels, menstrual irregularities, and/or
with genetic and environmental contributors
small cysts on one or both ovaries (1).It affects 5-
(6).Women with PCOS have defects in both
10% of reproductive-age women (2).Polycystic
peripheral, which reflects primarily skeletal
Ovary Syndrome can be described as an
muscle, and hepatic insulin action, as well as
oligogenic disorder in which the interaction of a
pancreatic -cell dysfunction (7).Chemerin is a
number of genetic and environmental factors
newly discovered adipokine that regulates
determine the heterogeneous, clinical, and
adipocyte development and metabolic function as
(1).The relationship
well as immune function (8).Chemerin may be one
between PCOS and obesity is complex, not well
of the most important links between adiposity and
understood, and most likely involves interaction of
insulin resistance, and thus a good clinical marker
genetic and environmental factors (3).Obesity leads
for metabolic dysfunction (9).Anti-Müllerian
to several co-morbidities, such as diabetes,
hormone (AMH) is a dimeric glycoprotein that
belongs to the transforming growth factor-beta
osteoarthritis, menstrual disorders, infertility, gout,
family. It is involved in the regression of the
stroke, ischemic heart disease, congestive heart
Mullerian ducts during male fetal development (10).
failure, deep vein thrombosis and pulmonary
So, this study was aimed to evaluate serum
embolism (4). Although not required for diagnosis,
levels of chemerin and AMH innormal weight and
obese patients with PCOS in one trial to show their
hyperinsulinemiais common and places those
possible involvement in the pathogenesis and
affected at increased risk of diabetes and
progression of PCOS and analyze their association
cardiovascular disease. Thus, PCOS adversely
with obesity.
affects endocrine, metabolic, and cardiovascular

health (5). Insulin resistance and concomitant
hyperinsulinemia are frequently found in obese
This study was performed on eighty subjects,
PCOS women and occurs in around 50% to 80%
their ages ranged between 22-37 years, selected
Received: 16/10/2017 DOI: 10.12816/0044533
Accepted: 26/10/2017

Full Paper (vol.707 paper# 5)

c:\work\Jor\vol707_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1111-1116

Meta-analysis on Subsyndromal Delirium in ICU
Moath Mohammad Alothman1 , Haitham Abdullah Alnahedh2 , Saleh Khader Alghamdi3 ,
Abdulrahman Khalid Aljarallah Intern 4 , Ghazi Abdulmalik ashoor5 , Hebah Adel Mansour 6 ,
Ramy Fahad Alshawan7 , Khalid Mohammed A Asiri8 , Muteb Lafi Alenazi 9 , Salem Abshan M
Alshehri 10, Khalid Nasser M Sinnah11 , Aisha Esam taiyeb12
1- PHC at Dammam City, 2- Al Iman General Hospital, 3- King Saud Medical City , 4- King Abdulaziz
University , 5- Alfaisal University , 6- Jeddah Eye Hospital, King Abdulaziz University , 7- Al Amal
Hospital , 8- Muhayel General Hospital , 9- Arar Central Hospital , 10- Prince Abdulaziz Bin Musaed
Hospital- Arar , 11- ACH ( Aseer Central Hospital ) , 12- King Abdullah Complex Hospital

Subsyndromal delirium (SSD) is a frequent condition and has been commonly described as an
intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on
clinically relevant outcomes in the intensive care unit (ICU) remains unclear.
Aim of the Study: To evaluate the significance of SSD on adverse clinical outcomes especially mortality and
length of hospital stay.
Methods: A systematic search was performed in the scientific database particularly MEDLINE (2000­2017),
EMBASE (2000­ 2017), Cochrane Central Register of Controlled Trials, CINAHL (2000­2017), Google Scholar,
and individual journals to identify publications that evaluated SSD in ICU patients.
Results: The search yielded five studies involving 2453 patients. SSD was detected in 849 patients (34.6%).
Three studies evaluated only surgical patients. Three studies used the Intensive Care Delirium Screening Checklist
(ICDSC) and two used the Confusion Assessment Method (CAM) score to diagnose SSD. The meta-analysis
showed an increased hospital length of stay (LOS) in SSD patients (0.29 (95% CI 0.11­0.48), p=0.002; I 2=33%).
Hospital mortality was described in two studies but it was not significant (hazard ratio 0.93 (0.58­1.43), p=0.88 and
(4 (1.0-6.9) vs 9 (3.6-20.4), p=0.05). The use of antipsychotics in SSD patients to prevent delirium was evaluated in
one study but it did not modify ICU LOS (6.2 (4­8) vs 7 (4­9) days, p=0.63 and 2 (2­3) vs 3 (2­3) days,
p=0.517) or mortality (9 (25.8%) vs 7 (20.4%), p=0.51).
Conclusion: Subsyndromal Delirium is a common and adverse condition that is manifested in almost one-third of
ICU patients. According to our findings, SSD has increased the length of hospital stay only with low impact on
the other outcomes. Nevertheless, studies on a bigger sample size and larger scale are needed for a better
understanding of the relevance of SSD in ICU patients as well as its treatment.
Keywords: Delirium, Intensive care, Outcome, Critical care, Cognitive abnormalities.

Intensive Care Delirium Screening Checklist
The cause/effect and correlative complexities of
(ICDSC) [6],and the Confusion Assessment Method-
illnesses affecting mind and body have moved into
ICU[7]. Each has been used as dichotomous marker
the mainstream of critical care medicine over the last
for delirium, i.e., they indicate that the patient either
decade[1]. Back then, researchers and clinicians have
has delirium or does not.
become aware of the importance of delirium in the

ICU. In 2004, a landmark study by Ely et al. reported
Importantly, various studies report wide ranges of
ICU delirium as an independent predictor of
ICU delirium incidences [8].While some of this
mortality as well as length of stay and cognitive
variation may be related to semantics[9] , other issues
impairment at hospital discharge[2].
such as ICU patient population, presence of
Delirium in the critically ill is common , morbid [3],
unrecognized chronic brain dysfunction, sedation
and distressing . These considerations as well as
practices, and timing of assessment(s) are other likely
expert guidelines [4] have fostered initiatives for
contributors to this variance. Furthermore, existing
reliable, easily applicable screening tools. Numerous
evidence suggests that ICU delirium is not a "one-size-
tools are available to assess delirium in hospitalized
fits-all" phenomenon. It is important to distinguish
patients outside the ICU [5]. Two scales tailored to
hypo- from hyperactive delirium, since the former may
mechanically ventilated patients have been validated
be associated with a worse outcome [10]. More recently
to screen for delirium in the critically ill: the
it has become clear that delirium in the ICU appears to
Received: 14/12/2017 DOI: 10.12816/0044534
Accepted: 24/12/2017

Full Paper (vol.707 paper# 6)

c:\work\Jor\vol707_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1117-1120

Imaging View of Arterial Tortuosity Syndrome - Case Report
Saleh F Alqahtani1, Ahmad A Alzoani2, Mohammed A Algathradi1,
Abdullah A Alhayani3, Metrek Almetrek4
1. College of Medicine, King Khalid University, Abha, 2. Department of Neonatology,
Abha Maternity and Children Hospital, Abha, 3. Department of Pediatrics, Abha Maternity
and Children Hospital, Abha, Saudi Arabia,4. Joint Program of Postgraduate Residency Training
Program of Family Medicine in Khamis Mushayte
Correspondence author: Saleh Fahad Abdullah Alqahtani, E-mail: saleh.fahad777@gmail.com

Arterial tortuosity syndrome is one of the autosomal recessive diseases and caused by
alterations (mutations) in the SLC2A10 gene. It is a rare disorder worldwide and in Saudi Arabia. Its
prevalence is unknown. In the medical literature, about 100 cases have been reported.
Objectives: An approach for how to diagnose a case of arterial tortuosity in newborn.
Material and methods: A radiological view report of a case aged 21 days old female baby patient
presented to emergency department with vomiting and fever for one week.
Results: She was managed in Abha Maternity and Child Hospital and referred to the tertiary center for
advanced management and follow up.
Conclusion: Arterial tortuosity syndrome usually presents with a different set of clinical features among
reported cases and its manifestations going with the mutation type.
Keywords: Arterial tortuosity, vomiting, fever


Arterial tortuosity syndrome is rare disorder
good tone, regular respiration and a heart rate <100
worldwide and in Saudi Arabia. Its prevalence is
pulses per minute, no resuscitation was required.
unknown. In the medical literature, about 100 cases
Baby admitted to Abha Maternity and Children
have been reported. Arterial tortuosity syndrome is
Hospital from the Emergency Department at the
one of the autosomal recessive diseases and caused
age of 21 days due to frequent projectile vomiting
by alterations (mutations) in the SLC2A10 gene (1).
that continued for one week before admission. The
Its clinical manifestations include vascular
baby was dehydrated and irritable. There was a
features like tortuosity and elongation of the major
history of fever. After admission to side room
arteries, pulmonary artery stenosis, pulmonary
abdominal ultrasound was done which confirmed
hypertension and non-vascular connective tissue
the diagnosis of pyloric stenosis, so baby shifted to
related symptoms like a hernia, dysmorphic facial
Neonatal Intensive Care Unit for surgical
features and joint and skin laxity (2).
Also, ventricular hypertrophy could be seen
Pyloromyotomy was carried out on 27/4/2017,
regularly. Many patients have an enormous face
and no post-operative complications reported.
with micrognathia (3).
After surgery a computed tomography
In 1967, Ertugrul described the first case of this
angiography was done which showed significant
diseases, and then numerous cases have been
tortuosity of the focal aorta and coarctation beyond
reported, but the exact nature of Arterial tortuosity
the branching of the left common carotid artery and
syndrome is unknown (3, 4).
left subclavian artery (aortic arch diameter = 7 mm
The study was done after approval of ethical
and the descending aorta diameter = 4 mm). Also,
board of King Khalid university.
there was early branching of the pulmonary arteries

with short pulmonary trunk and narrowing of the
left pulmonary artery at its bifurcation from the
A 21-days-old female baby patient presented to
pulmonary trunk. Besides, there was multiple
emergency department with vomiting and fever
collaterals in the right upper arm at the site of
since one week, she was born at full term gestation
contrast injection. Moreover, there was Pectus
spontaneously via vaginal rout at 28/3/2017. The
excavation of the sternum (Figure 1).
baby was vigorous at birth with
Received: 14/12/2017 DOI: 10.12816/0044535
Accepted: 24/12/2017

Full Paper (vol.707 paper# 7)

c:\work\Jor\vol707_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1121-1130

Systemic Review: Role of Tissue Plasminogen Activator for
Acute Ischemic Stroke
Abdullah Musari Alanazi, Abdullah Munif Al-Enezi, Khalid Hashim Alanazi,
Muteb Lafi Alanazi, Nasser Nidaa Alanazi.
Northern Border University

Background: Using recombinant tissue plasminogen activator (rt-PA) during the first 3 h up to 6 h of
stroke was allowed to reduce the poor functional consequences of stroke.
Objectives: assess the effects of intravenous dosage of rt-PA during the first 6 h after on early and late
outcomes of acute ischemic stroke (AIS).
Methods: all studies regarding the intravenous rt-PA given within 6 h of onset of acute ischemic stroke up
to 2016 were searched the outcomes, and the mortality rates were evaluated at the final follow up.
Results: There was a significant increase in functional outcome by using IV-tPA significantly (p <0.01).
A significant decrease was found in intracranial hemorrhage in the patients treated with IV-tPA. The
mortality rates were significantly decreased at the end of the follow up period in patients treated with IV-
Conclusion: The study indicated that using intravenous rt-PA could increase the number of living patients
favorable outcome, less disabilities and intracranial hemorrhage among acute ischemic stroke patients
during the first 6 hours.
Keywords: Systemic review, tissue plasminogen activator, acute ischaemic stroke, mortality.


Acute ischemic stroke (AIS) is a worldwide
Information sources and search strategy
cause of disability and death accounting about
The electronic database search included 1995 to
87% of the stroke cases. The occlusion of the
2016, Data extraction and quality assessment.
arteries causes blood deprivation and cell death
Using predetermined forms, data were extracted
associated with neural dysfunction(1, 2).
independently by two authors. Data were
The most effective treatment for AIS is
collected on study design and conduct, country of
intravenous thrombolysis which could reverse the
study, sample size, and outcome.
arterial occlusion and decrease the number of
From each study, outcome data were extracted
damaged cells as well as improving the recovery
in 2x2 tables or using the mean and SD. Study
and decreasing the rates of death. Another
quality assessment was performed using
advantage of using intravenous thrombolysis
QUADAS-2 (Quality Assessment for Diagnostic
during the early period of stroke would result in
Accuracy Studies-2: A Revised Tool) for
significant improving in the neurological
evaluating the diagnostic accuracy of studies (11).
functions(3, 4).
The tool consists of four key domains covering
patient selection, index test(s), reference
activator (rt-PA) during the first 3 h up to 6 h of
standard, the flow and timing. Each domain was
stroke was allowed in patients younger than 80
assessed in terms of risk of bias, and the first
years(5, 6). Also, other studies showed that after 6
three domains were also assessed for concerns
h the treatment with rt-PA could result in
regarding applicability. Signaling questions were
reducing the poor functional consequences of
included in the tool to help judge the risk of bias.
stroke (7, 8).
The index test(s) for the included studies were the
There is increasing evidence regarding treating
biomarkers and the reference standard.
the AIS with rt-PA after 6 hours, however, other

factors would affect the outcomes including
Inclusion Criteria
previous chronic diseases including hypertension,
The inclusion criteria for the systematic
heart diseases and diabetes, stroke severity,
review were all prospective studies with use of
subtypes and previous usage of antiplatelet
Tissue Plasminogen Activator for Acute Ischemic
drugs(9, 10). This is a systemic review conducted to
Stroke. Exclusion criteria were retrospective
assess the effects of intravenous dosage of rt-PA
studies, case reports, case series, letters, and
during the first 6 h after on early and late
reviews; studies that did not include tissue
outcomes of AIS.
plasminogen activator as a treatment. Studies in
Received: 15/12/2017 DOI: 10.12816/0044536
Accepted: 25/12/2017

Full Paper (vol.707 paper# 8)

c:\work\Jor\vol707_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1131-1134

The Relationship between Sleep Patterns and Academic
Performance among Medical Students at King Saud
Bin Abdulaziz University for Health Sciences
Nasser Alhazzani, Emad Masudi, Abdularhman Algarni
King Saud Bin Abdulaziz University, Riyadh KSA

Background: the relationship between the sleep pattern and the academic performance among medical
students is not well addressed in the literature. This study aimed to assess the association between sleep
pattern and academic performance among medical students at King Saud Bin Abdulaziz University for
Medical Sciences.
Methods: this descriptive cross-sectional study was conducted on male medical students at King Saud Bin
Abdulaziz University for Health Sciences at Riyadh, Saudi Arabia. They were included and the Exclusion
criteria were students in Basic sciences phase and preparatory phase. The questionnaire was obtained from
Groninger Sleep Quality Questionnaire and it was distributed through official university email. Responding
rate was 25.7%(n=166) out of 645 students whom were included. SPSS was used to manage and analyze the
Results: the majority of students (27.1%) who showed adequate sleep had GPA of between 3.5 and 4.49
which was referred to good academic performance. 0.6% of those who showed adequate sleep score less than
2.5 GPA. On the other hand, 22.9% of the students showed inadequate sleep score GPA of between 3.5 and
4.49. Conclusions: our results showed that sleep quantity and quality doesn't play significant roles in
academic performance of students. Nevertheless, students should adopt a healthy sleep pattern.
Keywords: sleep pattern, academic performance, sleep quality, sleep quantity.
Ethical approval was granted by the ethical review board of King Fahad Medical city ,Riyadh city , KSA.


Sleep is defined as "a state that is characterized
population of medical students is 93.2% (7,8).
by changes in brain wave activity, breathing, heart
Furthermore, sleep pattern of medical students
rate, body temperature and other physiological
is characterized by inadequate sleep duration, late
functions" (1). Sleep deprivation leads to sleepiness
sleep onset and napping during school day (9,10)
during daytime, which may contribute to medical
.Studies found that female students are affected by
errors, road traffic accidents and decrease in
sleep disorders more than males (11,12).
academic performance (2).
A cross-sectional study was done at King Saud
In addition, lack of sleep might result in
University College of Medicine. The research
irritability, impatience, inability to focus and
concluded that poor academic performance of
moodiness. Sleep helps the brain to process
medical students was associated with reduced
memory and learning by a mechanism called
amount of sleep at night (3). Undergraduate
memory consolidation (3). Excessive daytime
students of psychology at multiple universities in
sleepiness has negative consequences on cognition
USA participated in a cross-sectional study was
and behavior (4).
published in 2001. They found that overall low
Sleep duration varies across ages and is
grade point average is highly found with short
dependent on the individual's general health,
sleepers (13).
mental status and physiological alterations (5). The
At the University of Minnesota, a study found a
average sleep duration among adults ranged
strong positive correlation between GPA and
between 7.5 and 9 hours per night. This sleep
quantity of sleep per night (14). At 2012, medical
period was optimal in order to restore normal
students in University of Munich, Pittsburgh sleep
physiological and psychological functions of the
quality index was used to evaluate sleep quality. A
body (6). In the context of medical students, the
study demonstrated that test performance may be
daily schedule is full of academic lectures, hospital
impacted by poor sleep quality (15).
activities and emotional events such as dealing
Another cross-sectional study was conducted
with patients who are suffering or dying. Research
by Grant MacEwan College in Edmonton. The
authors described used the Epworth Sleepiness
excessive daytime sleepiness (EDS) among the
Scale and Pittsburgh Sleep Quality Index. They
Received: 15/12/2017 DOI: 10.12816/0044537
Accepted: 25/12/2017

Full Paper (vol.707 paper# 9)

c:\work\Jor\vol707_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1135-1136

Squamous Cell Carcinoma Presenting as Cutaneous Horn: A Case Report
Samaher Alaauldeen1, Khalid Al Hawsawi2, Haneen Al Sufyani3, Lina Bugis4,
Ayat Al Dosari5, Taghreed Al Hetairshi5
1- Al-Noor Specialist Hospital, Makkah, Saudi Arabia, 2- Dermatology Department,
King Abdul Aziz Hospital Makkah, Saudi Arabia, 3- King Abdul Aziz Hospital Makkah, Saudi
Arabia, 4- Umm Al Qura University Makkah, Saudi Arabia, 5- Makkah, Saudi Arabia

Cutaneous horn is a clinical term used to describe a hard, keratotic conical lesion. Its base may
be a papule, plaque or nodule. Objectives: An approach for how to diagnose and manage a cutaneous horn.
Materials and methods: Here-in we report an aged male 85-years old presented with a history of painful
slowly progressive skin lesion over his right foot 7 months ago.
Results: The past medical history revealed that the lesion was preceded by presence of a cutaneous horn (CH)
at the same site of the current skin lesion. That CH was persistent for a year before it spontaneously fell down.
Skin biopsy from the base of the CH was taken at that time, it was consistent with underlying actinic keratosis.
He did not receive any treatment for his CH. Currently skin examination revealed fungating ulcer measuring
6X6 cm on the dorsum of the right foot. There was no inguinal lymphadenopathy. Punch skin biopsy was
taken from the edge of the ulcer for histo-pathological examination.
Conclusion: On the basis of the above clinicopathological findings, a diagnosis of well differentiated
Squamous Cell Carcinoma was made. The patient was referred to Oncologist for appropriate management.
Keywords: Cutaneous horns, Cornu Cutaneum, Squamous Cell Carcinoma, Ulcer.

unremarkable. Family history revealed no
Cutaneous horn is a clinical term for a hard,
history of malignancy in the family. Skin
keratotic conical lesion. It occurs commonly in sun
examination revealed fungating ulcer measuring
exposed sites such as face, eyelid, ear, neck and
6X6 cm on the dorsum of the right foot (figure 1).
dorsal aspects of hands[1]. The histopathology of
No inguinal lymphadenopathy was detected.
horn is unique in its vertically oriented column of
Punch skin biopsy was taken from the edge of
massive hyperkeratosis, parakeratosis and variable
the ulcer. The epidermis revealed full-thickness
acanthosis usually in association with atypical
atypical keratinocytes with downward proliferation
keratinocytes of an actinic keratosis[2]. Other
of lobules of atypical keratinocytes deep into the
lesions that are associated with cutaneous horns
dermis. The nuclei of these keratinocytes showed
include such seborrheic keratosis, histocytoma,
some degree of pleomorphism and mitoses. Also,
viral warts, molluscum contagiosum, epithelial
there were keratin pearls and moderately dense
neoplasms especially tricholemmomas, Bowen's
lymphohistiocytic cellular infiltrates in-between the
disease, squamous cell carcinoma (SCC), Basel cell
epithelial lobules in the dermis (figure 2).
carcinoma, granular cell tumor, metastatic renal
On the basis of the above clinicopathological
carcinoma, sebaceous carcinoma or Kaposi
findings, a diagnosis of well differentiated
sarcoma [1-5].
squamous cell carcinoma was made. The patient
The study was done after approval of ethical
was referred to Oncologist for appropriate
board of King Abdulaziz Hospital.

An aged male 85-years old presented with a

history of painful slowly progressive skin lesion

over his right foot 7 months ago.

The past history revealed that the lesion was

preceded by presence of a cutaneous horn (CH) at

the same site of the current skin lesion. That horn

was persistent for a year before it spontaneously

fell down. Skin biopsy from the base of the CH was

taken at that time. It was consistent with the

underlying actinic keratosis. He did not receive any

treatment for his CH. Review of systems was

Figure 1. Fungating ulcer measuring 6X6 cm on
the dorsum of the right foot.
Received: 5/12/2017 DOI: 10.12816/0044538
Accepted: 25/12/2017

Full Paper (vol.707 paper# 10)

c:\work\Jor\vol707_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1137-1139

Prevalence of Benign Prostatic Hyperplasia (BPH) in
Saudi Patients above 40 Years Old
Markhan Hammad Almarkhan, Abdullah Ismail Sawma, Fahad Saleh Alruwaili, Qusai Abdullah
Alsaqabi, Mushari Aber Alonazi, Waleed Sultan Alruwaili, Nafea Hamoud Alanazi
Al-jouf University, Collage of Medicine
Corresponding author: Markhan Hammad Almarkhan, 0966558505953, E-mail: m.almrkhan@gmail.com

Background: Benign prostatic hyperplasia (BPH) is a common disorder amongst older men, and is accountable
for significant disability. Objective: The aim of the study is to determine the prevalence of benign prostatic
hyperplasia in urology department of Prince Mutaib hospital in Sakaka, Aljouf.
Methods: Via recoding, 345 patients attended the urology department. They were asked about their ages, if they
are smokers and if they have chronic diseases.
Results: The total number of patients diagnosed as having benign prostatic hyperplasia (BPH) was 82. This
showed a prevalence rate of 23%. The age distribution of the patients was found to be above 60 years old. While
regarding the symptoms: 23 (28%) of the patients showed mild BPH, 39 (48%) with moderate BPH, and 20
(24%) with severe BPH. Conclusion and recommendation: BPH seemed to be a problem of elderly patients, as
within the studied patients, those with BPH were above 60 years. Chronic diseases such as diabetes mellitus,
hypertension may be acting as risk factors for BPH. Further studies are recommended to study the prevalence of
prostatic carcinoma in elderly patients.
Benign prostatic hyperplasia, Diagnosed, Chronic diseases.


The prostate is a gland that produces the fluid

that conveys sperm throughout the ejaculation. The
In Sakaka, Al-jouf there were no researches that
prostate gland surroundings the urethra, the tube
studied this topic yet, and this is the first reason to
over which urine moves out of the body. On the
choose this topic benign prostatic hyperplasia
other hand, an enlarged prostate attempts that the
(BPH) and the second reason is the importance of
gland has grown bigger. Moreover, prostate
prostatic symptoms among patients above 40 years
enlargement infects almost all men as they get
old which is common and more likely by the age of
older. As the gland produces, it can press on the
urethra leading to difficulty in urination [1].
It can also complicate as sudden inability to
The study aimed to assess the prevalence of
urinate (urinary retention), urinary tract
BPH among patients of ages above 40 years
infections (UTIs), bladder stones, bladder
presenting with prostatic symptoms visiting the
damage and kidney damage [2].
urology unit of Prince Mutaib hospital in Sakaka.

Although benign prostatic hyperplasia (BPH) is
a common problem among older men, and is
Subjects: All patients recorded at the urology
responsible for considerable disability to urination,
department from January 2015 to March 2015.
however, it is an infrequent cause of death.
They have been assessed to check if they were
According to the World Health Organization
suffering from Benign Prostatic Hyperplasia.
database, the mortality rates for most developed
Design: Hospital-based retrospective study.
countries in the 1980s were 0.5 to 1.5/100,000 [3].
Data Collection: Patients attended the urology
The most common type of prostatic disorders in
department and diagnosed as BPH with information
patients above 40 years old is benign prostatic
as regard the patient's age, smoking, and chronic
hyperplasia, by the age of 60 more than half of men
have BPH. However by the age of 85 year old, 90%
The prevalence of BPH was assessed by using
of men will be bothered by their symptoms of
of International Prostatic Symptom Score (IPSS),
the total score ranges from 0 to 35, with a higher
Received: 16/12/2017 DOI: 10.12816/0044539
Accepted: 26/12/2017

Full Paper (vol.707 paper# 11)

c:\work\Jor\vol707_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1140-1148

The Correlation between Vitamin D and Polycystic Ovary Syndrome
Ameen Mohammed H. Malky 1 , Fatimah Mohammed Al khudhyr2 , MohammedAleanAlbalawi3 ,
MohammedYarub Hafez4 , Abdullah Hamad Almutairi5 , Abdulmajeed Hassan aljohani6 , Saud Adel
Al-Taisan 7 , fahadsaeedmohmmedalnwehedh8 , Amany Ali Alghamdi 9 , Rawan Khalid AlBraik10 ,
Abeer Muidh A Alzahrani11 , Yousra Jaber Y Muharraq12
1- Umm Al-qura university ,2- Dammam University , 3- GP INmadinah PHC , 4- Jeddah Alsulimania PHC
, 5- Tabuk university , 6- King Saud bin Abdulaziz for Health Science in Riyadh , 7- Al-Ahsa (Al-Salmaniah
PHC) , 8- Medicine Resident at the Armed Forces Hospital in South Region , 9- ibn sina national college , 10-
salmaniya medical complex- (Bahrain) , 11- King Abdulaziz University , 12- Jazan University

A deficiency of Vitamin D not only causes poor bone mineralization but also has been implicated
in many other chronic diseases. Recent studies have suggested a relevance of vitamin D to reproductive
physiology. Moreover, recent evidence is establishing to support the hypothesis that vitamin D status may
contribute to the development of metabolic disturbances in PCOS.
Aim of the Study: To investigate the relationship between Vitamin D level and polymorphisms related to
metabolic disturbances particularly Insulin resistance in women with PCOS.
Methods: A review of the scientific literature (PubMed Search 1960 to 2017)
Pubmed, Embase and CENTRAL were searched to identify randomized controlled trials that investigated
The Correlation between Depression and Folate Deficiency as the primary outcome. Identification of papers
and data extraction were performed by two independent researchers.
We searched for relevant trials in the Cochrane Library, MEDLINE (from 1960), Embase (from 1960), and
ongoing trial databases; all searches current to October 2017.
Results: Eight studies were included enrolling 1225 women; 779 patients with depression and 446 control
subjects. Univariate regression analyses of the weighted means indicated a significant correlation between
vitamin D and IR predictability in both PCOS and control women. However, the significance was neutralized
after factoring BMI in PCOS women.
Conclusion: There is a growing body of evidence suggesting an inverse association between vitamin D status
and metabolic disturbances in PCOS in the current literature yet heterogeneity of the conducted studies made it
difficult to come out with a solid conclusion. Nevertheless, normalization of vitamin D levels is recommended
generally and especially for PCOS patients.
Keywords: Vitamin D; Insulin resistance; Infertility; PCOS women.

primordial follicles and primary and secondary
Polycystic ovary syndrome (PCOS) is a common
follicles are significantly increased. However, due
heterogeneous endocrine disorder characterized by
to derangements in factors involved in normal
irregular menses, hyper androgenism, and
follicular development, follicular growth becomes
polycystic ovaries. PCOS is characterized by
arrested as follicles reach a diameter of 4­8 mm.
hyperandrogenism, ovulatory dysfunction, and
Because a dominant follicle does not develop,
polycystic ovaries. However, there is considerable
ovulation does not ensue [2].
interindividual variation in presentation. Although
In addition, spontaneous abortion occurs more
not required for diagnosis, the presence of insulin
frequently in PCOS with incidences ranging from
resistance and hyperinsulinemia is common and
places those affected at increased risk of diabetes
On a separate note, Vitamin D is a fat-soluble
and cardiovascular disease[1] . Thus, PCOS
vitamin that belongs to the family of steroid
adversely affects endocrine, metabolic, and
hormones. The biological actions of vitamin D are
cardiovascular health.
exerted through a soluble protein, the vitamin D
Approximately 90%­95% of anovulatory women
receptor (VDR). VDR is a transcription factor
presenting to infertility clinics have PCOS.
located in the nuclei of target cells that mediates
Women with PCOS have a normal number of
the genomic action of the active form of vitamin D
Received: 17/12/2017 DOI: 10.12816/0044540
Accepted: 27/12/2017

Full Paper (vol.707 paper# 12)

c:\work\Jor\vol707_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1149-1151

Pediatric Disseminated Bacillus Calmette-Guerin
Infection (BCGitis): A Case Report
Abdullah A. Alesa1, Hamed M. Aljiffry1, Khalid A. Alqurashi1, Khalid A. Alghamdi2,
Mohammad A. Batouk3, Alaa A. Alesa1
King Saud Bin Abdulaziz University for Health Science (KSAU-HS) ­ Jeddah,1 Ibn Sina National College for
Medical Studies,2 King Abdulaziz University ­ Jeddah3
*Corresponding Author: Abdullah A. Alesa, Email: Alesa.m.d@gmail.com

BCG is a live attenuated vaccine. It has been used to prevent tuberculosis since 1921. BCG is
widely used, it is estimated that 100 million newborns are receiving it yearly. It also has a low incidence of
serious adverse reactions and considered safe. However, few severe complications have been reported despite
its wide use. Adverse reactions of BCG vaccination included suppurative lymphadenitis, localized abscess or a
combination of both. In addition to them there was disseminated BCG-itis, which is life threatening, but very
rare. Aim of the work: this study reported a case of a five-month-old child with BCG-itis which presented to
us. Patient and method: left axillary swelling was increased in size with bloody discharge and associated
fever. Family history of IL12 deficiency was also noted.
Results: diagnosis was made by AFB and PCR. The child responded well to anti-mycobacterial treatment.
Because neonatal BCG vaccine is included in many standard vaccination schedules around the world, it is
extremely difficult to avoid administering it to infants who might have PID. Conclusion: it is important to
recognize BCG adverse reactions because they can be the first clue to diagnosing immunodeficiencies.
Keywords: BCG, Immunodeficiency.


Bacille Calmette-Guérin (BCG) vaccine which
in size with bloody discharge for two months
is a live attenuated vaccine, has been used to
prevent tuberculosis since 1921 and was
The study was done after approval of ethical
incorporated in the World Health Organization's
board of King Saud Bin Abdulaziz university
Expanded Program on Immunization in 1974 to

enhance the fight regarding pediatric tuberculosis in
developing countries (1). Although its efficacy is
Eight-month old boy was in his usual state of
controversial, there is an agreement in the medical
health until the age of five months when he started
community about the role that it has in the fight
to have a deltoid swelling at the site of the BCG
against meningitis and disseminated disease in
vaccine scar. The swelling was fluctuating in size
pediatric tuberculosis (2).
with marked erythema and bloody discharge. There
The BCG vaccine is widely used, it is
was also oozing with changing of clothes or upon
estimated that 100 million newborns are receiving it
touching the swelling on virtually daily basis as
yearly. It also has a low incidence of serious
reported by the child's mother. The swelling was
adverse reactions and generally it is considered
associated with intermittent Fever.
safe. However, few severe complications have been
The family sought medial advice many times, but
reported despite its wide use (3). Adverse reactions
were always reassured, until the child was eight
and complications of BCG vaccination included
months old when he presented to our hospital
suppurative lymphadenitis, localized abscess or a
complaining of a left axillary swelling that was
combination of both. In addition to them there is
increasing in size with bloody discharge. There was
disseminated BCG-itis, which is very rare, but is
also associated erythema, pain and persistent
considered the most serious adverse reaction related
crying. The patient's family denied any history of
to BCG vaccination (4). In this paper, we discussed
weight loss, night sweats or contact with TB
a case BCG-itis in five months old boy who
patients. Remarkable family history of same
presented to our hospital with a left axillary
complaint and infantile death from father's side.
swelling increasing
Family history of IL 12 deficiency was also
Received: 17/12/2017 DOI: 10.12816/0044541
Accepted: 27/12/2017

Full Paper (vol.707 paper# 13)

c:\work\Jor\vol707_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1152-1158

The Prevalence and Patterns of Carpal Tunnel Syndrome and Their
Associated Risk Factors Among Diabetic Population In
South-West of Kingdom of Saudi Arabia
Saud Nawar S. Alotaibi, Saeed Saad M. Alqahtani, Rayan Mohammed S. Alammar,
Mohammed Saeed A. Alqahtani, Salem Abshan M. Alshehri, Sami Fayez S. Alshehri,
Abdullah Khalid A. Asiri and Sami Amer M. Alqarni
Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
Carpal tunnel syndrome (CTS) is a constellation of symptoms and signs resulting from the local
compression of the median nerve inside the carpal tunnel at the wrist. In advanced cases of CTS where the course
is unnoticed, atrophy of the thenar muscles may occur, which can be irreversible.
Objective: The aim of the present study was to estimate prevalence and severity of CTS in patients with type 2
diabetes mellitus in South Western region of the Kingdom of Saudi Arabia (KSA) and to identify specific at risk
groups within these populations by using nerve conduction study.
Methods: This cross-sectional study was conducted in Asir Central Hospital, Abha, KSA. The study randomly
included all patients with type 2 diabetes mellitus with their place of birth and permanent residence being in Abha
or Mohyel cities. History, physical examination, and laboratory data about fasting blood glucose, HbA1c, and
lipid profile were collected. Additionally, nerve conduction study of both hands was performed.
Results: Out of 131 included subjects, 107 patients (81.7%) had CTS. Approximately one-third (35.1%) of the
study subjects had unilateral CTS, and it affected both hands in 46.6% of them. In the majority of cases CTS was
of very mild or mild severity (27.5% and 26.7% respectively). A significant association was found between
gender, hypertension, hypothyroidism, ischemic heart disease and the development of CTS.
Conclusion: High prevalence of unilateral and bilateral CTS was found among patients with type 2 diabetes
mellitus in South Western Saudi Arabia. Different grades of CTS were detected, but the severity of functional
impairment was relatively mild. Development of CTS was associated with hypertension, ischemic heart disease,
and hypothyroidism. Health care professionals should be aware of this high prevalence, and it will be useful to
perform electrodiagnostic studies in diabetic patients in whom CTS is suspected.
Keywords: carpal tunnel syndrome; type 2 diabetes mellitus; electrodiagnostic study; prevalence; severity; risk
factor; Saudi Arabia.


CTS ranges from 0.125% to 1%, and the prevalence
Carpal tunnel syndrome (CTS) is a
rate is approximately 5% to 16% depending upon the
constellation of symptoms and signs resulting from
criteria used for the diagnosis(5). It is considered as
the local compression of the median nerve inside the
an occupational disease with high prevalence rates
carpal tunnel at the wrist, which results in functional
among certain occupations(6). The prevalence rate
impairment and local ischemia of the nerve within
among adult general population ranges from2.7% to
the tunnel(1). It is characterized clinically by the
5.8%(7). Most cases of CTS are idiopathic, although
presence of sensory symptoms in the form of
the risk of its development appears partly to be
numbness, tingling, pain, and feeling of heaviness of
associated with different local and systemic factors,
one or both hands. Motor involvement and
including genetic, medical, social, vocational, and
functional impairment of the hand functions can
demographic, such as inflammatory diseases, for
occur in more severe cases if the CTS release
example, rheumatoid arthritis, and systemic
surgery is not done within reasonable time(2).
CTS diagnosis is based on characteristic
symptoms and positive different provocative stress
Occupational risk factors in the form of repetitive,
tests such as Phalen's test, Tinel's test, or hand
forceful flexion and extension of the wrist and
elevation test on physical examination. It is
fingers may also contribute to CTS symptoms(8,9).
confirmed by electrodiagnostic studies(3). The
In advanced cases of CTS, where the course
prognosis and therapeutic measures are highly
is unnoticed, atrophy of the thenar muscles may
related to severity assessment of CTS using different
occur and it can be irreversible(1). Hence, the aim of
nerve conduction studies(4). The incidence rate of
the present study was to estimate prevalence and
Received: 17/12/2017 DOI: 10.12816/0044542
Accepted: 27/12/2017

Full Paper (vol.707 paper# 14)

c:\work\Jor\vol707_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1159-1163

Asthma among Adolescent Secondary-School Girls in Riyadh City, Saudi Arabia
Raed Khalid R Alanazi 1, Nidhal Ibrahim Bahadir2, Abdulaziz Abdulhi Alghamdi3,
Omar Mohammed Almutairi4, Zayed Mufareh A Alzayed 5, Sarah Saeed Al Amoudi6,
Madihah Nafea S Alruwaili 1, Bader Ahmad H Albeity7 and Anas Osama Shahadah8
1 Northern Border University, Arar , 2 Aljorf Primary Care Center , Almadinah Almunwarah,
3 Psychiatric Hospital Baljurashi , Baljurashi, 4 Alnuzhah Primary Health Care , Riyadh,
5 King Khalid University , Abha, 6 Alfaisal University, Riyadh, 7Jordan University of Science &
Technology, Jordan , 8 Ohud Hospital, Almadinah Almunwarah, KSA
Asthma is one of the most common chronic diseases in children and adults. The prevalence of
asthma has increased in developed and developing countries over the last three decades. Our objective was to
estimate the prevalence of physician-diagnosed asthma and to describe some related characteristics and
associated symptoms of cases in a sample of adolescent secondary-school girls of Riyadh city, Saudi Arabia.
Methods: A descriptive cross-sectional study was conducted in secondary schools in Riyadh city, during the
academic year 2016-2017. A predesigned questionnaire was disseminated to the targeted population to
complete it. Results: Out of 154 female students, the prevalence of physician-diagnosed asthma was 4.5%.
The prevalence of rhinitis symptoms, exercise-induced wheezing and night coughing in the past 12 months in
physician-diagnosed asthma and exercise-induced wheeze was 42.9%, 28.6% and 28.6%, respectively.
Conclusion and recommendations: The prevalence of physician-diagnosed asthma in female adolescents in
Riyadh, Saudi Arabia was 4.5%, there was with a high rate (42.9%)of rhinitis symptoms among the asthmatic
girls. The prevalence of asthma in Riyadh, Saudi Arabia was within the reported prevalence ranges from
many other parts of the world. Health education sittings is recommended to increase the public awareness
about the causes and importance of seeking medical care during and between the attacks of asthma, especially
in adolescent period.
Keywords: Prevalence; Physician-diagnosed asthma; Adolescents; Secondary school girls; Riyadh city,
Saudi Arabia.

or early morning. The variable airflow obstruction
Asthma is one of the most common chronic
is often reversible, either spontaneously or by
diseases in adolescents around the world. The
treatment with bronchodilators or corticosteroids
prevalence of asthma has increased in developed
[5]. The global prevalence of asthma is difficult to
and developing countries over the last few
estimate because of the lack of a definitive
decades. The burden of asthma is of public health
diagnostic test and different methods of diagnosis
concern because asthma is a major cause of
and assessing asthma in epidemiological studies
infirmity, and reduces the quality of life of
[1].The prevalence of asthma in Saudi Arabia has
affected individuals. Asthma has become a focus
been investigated in several previous studies. Al
of clinical research and public health programs as
Frayh et al. conducted epidemiological studies in
a common chronic disease responsible for
Saudi Arabia in 1986 and 1995 and showed that
considerable morbidity and mortality [1]. It is a
the prevalence of asthma in comparable
chronic respiratory inflammatory disorder of the
populations increased from 8% to 23%,
airways that is characterized by episodes or attacks
respectively [6]. Another study was done by Hijazi
of impaired breathing, affecting up to 10% of
et al. in which he investigated the prevalence of
adults and 30% of children and adolescents [2].
asthma in 1,020 urban and 424 rural children and
During the childhood and adolescence period,
found that the prevalence of asthma was 13.9%
bronchial asthma is often underdiagnosed and
and 8%, respectively [7]. Also Al-Dawood et al.
undertreated, which may lead to severe
reported that the prevalence of physician-
psychosocial disturbances in the family [3].
diagnosed asthma in school-age boys was 8% [8].
Diagnosis is often missed or delayed due to the
Similarly, Alshehri et al. found that the prevalence
dynamic nature of the disease, unreliable past
of asthma in school-age boys was 9% [9]. Our
history or poor documentation of past episodes
study was done as an estimation of magnitude of
and lack of specific and sensitive diagnostic
the problem in Riyadh city nowadays. In this study
investigations [4]. The clinical picture of
we surveyed a total of 154 adolescent girls in
asthma includes bronchial hyperresponsiveness,
Riyadh city, KSA. The role of several risk factors
recurrent attacks of wheezing, shortness of breath,
was also evaluated in order to assess the
chest tightness and coughing, particularly at night
association with asthma.
Received: 17/12/2017 DOI: 10.12816/0044543
Accepted: 27/12/2017

Full Paper (vol.707 paper# 15)

c:\work\Jor\vol707_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1164-1168

Relation between Narrowed Coracohumeral Distance and Subscapularis Tears
Motaz Mohammed A Ashoor 1 , Waddah Majed Hamed 2 , Hussam Musallam Alfarsi 2 , Yousef Saleh
Alwosidi 3 , Hassan Talal Abdulaziz Alqudaihi 4 , Abdulrahman Samir M Khateiri 5 , Abdullah Faisal

G Shalabi 2 , Abdullah Mohammed A Alqarni 6 , Ramy Fahad Alshawan 7 , Ziyad Abdulrahman
Alrzoq 8 , Sohaib Kamal Filemban 2 , Hassan Abdullah Essa Albusaysi 9
1- Radiology Service, King Abdualaziz Hospital, 2- King Abdulaziz University, 3- King Saud Bin
Abdulaziz University for Health Sciences, 4- Imam Abdulrahman Bin Faisal University,
5- Ohud Hospital, Service ,6- PJC In Riyadh, 7- Al Amal Hospital,
8- KSMC, 9- University of Science and Technology
The Purpose of this study is to detect differences between the values of dynamic coracohumeral
distance (CHD) measured using ultrasonography (USG) in different shoulder rotations and to investigate its
correlation with subscapularis tear.
We prospectively enrolled consecutive patients (n = 84) who were scheduled to have arthroscopic
rotator cuff repair. Patients with a history of previous shoulder surgery or shoulder fracture and patients with
external rotation less than 30 were excluded from the study. Dynamic coracohumeral distance was measured
utilizing ultrasonography in 3 different shoulder positions: external rotation, neutral and internal rotation. We
assessed the intrarater reliability with 3 times repetition of measurement. Patients were divided into one of 3
groups according to arthroscopic findings: intact subscapularis, partial-thickness tear, and full-thickness tear
of the subscapularis. The control group (n = 12) included patients without rotator cuff tears from the
outpatient clinic. Subgroup analysis according to the presence of dynamic subcoracoid stenosis, defined as a
coracohumeral distance less than 6 mm measured in internal rotation was performed to find the clinical effect
of dynamic subcoracoid stenosis.
A partial-thickness tear of the subscapularis tendon was present in 30 patients (35.7%) and a full-
thickness tear in 13 patients (15.5%) among 84 patients. The CHD was maximum in external rotation and the
narrowest in internal rotation. There were no statistical differences in the CHDs between groups with
different subscapularis tear status. According to the presence of dynamic subcoracoid stenosis, patients with
dynamic subcoracoid stenosis had a significantly higher incidence of partial-thickness subscapularis tear than
those without stenosis (P = 0.018).
The coracohumeral distance values were narrowest in shoulder internal rotation, which is
thought to be the pathogenic position. We could not confirm the correlation between coracohumeral distance
and subscapularis tear. However, patients who have dynamic subcoracoid stenosis had significantly higher
incidence of subscapularis tear than others without dynamic stenosis.
Coracohumeral Distance, Subcoracoid Stenosis, Subscapularis Tears.

ultrasonography (USG) may reflect the actual
Numerous authors have described the frequency
subcoracoid stenosis procedure.
of the subscapularis tears to be higher than
The present study designed to:
previously thought (1-3), so subscapularis tears have

detect differences between the values of
lately become a focus of clinical practice and
dynamic CHD measured using USG in different
research. In an effort to explain the etiology of
shoulder rotations investigate its correlation with
subscapularis tears, studies have examined if
subscapularis tears. The hypothesis was that the
subcoracoid stenosis, an interval of less than 6 mm
dynamic CHD measured using USG varies along
between the coracoids and humeral head (4, 5), is
with the shoulder rotation and would be inversely
related to partial- or full-thickness tears of the
proportional to the likelihood of subscapularis tears.
subscapularis tendon (5, 6). Several authors have used

computed tomography or magnetic resonance
imaging (MRI) to evaluate the coracohumeral
From April 2016 to February 2017, we
distance (CHD) (6, 7). Nonetheless, impingement is a
prospectively enrolled 84 consecutive patients who
dynamic procedure, and symptoms of subcoracoid
met the following inclusion criteria without
impingement comprise pain in the anterior shoulder,
randomization: (1) had rotator cuff tear verified
particularly in forward flexion and internal rotation
through preoperative MRI and (2) were scheduled
(1). Consequently, measuring CHD utilizing static
to undergo arthroscopic rotator cuff repair.
imaging modalities, for instance computed
Exclusion criteria from the study were a history of
tomography or MRI, could be limited when bearing
rotator cuff surgery; a passive external rotation less
in mind the pathogenic nature of subscapularis tear
than 30 with the arm at the patient's side, as this
(8); though, measuring dynamic CHD using
was the only significant limiting factor for the
Received: 18/12/2017 DOI: 10.12816/0044544
Accepted: 28/12/2017

Full Paper (vol.707 paper# 16)

c:\work\Jor\vol707_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1169-1173

Evaluation of Patients with Iron Deficiency Anemia
Mohannad Ali S Alomari 1, Sultan Ali M Alshehri 2 , Ehab Osama Mugharbal 3 ,
Yousef Mohammed Alhazmi 4 , Mohammed Ammar A Almoabadi 5 , Maram Adnan Rawah 6 ,
Ayat Essam Shaban 7 , Rabab Abdulrazaq S Makkawi 8 , Leena Abdulaziz Y Alsaiari 5 ,
Mohammed Adil H Alqadheeb 9 , Naif Enad Alanazi 10 , Mohammed Yarub Hafez 11
1- Najran University Hospital, 2- Almujardah General Hospital, 3- Ohud Hospital,
4- Al Amal Mental Health Complex, 5- King Abdulaziz University, 6- Jeddah Eye Hospital,
7- Al Nahdah PHC, 8- MCH PHC , 9- Imam Abdulrahman Bin Faisal University ,
10- King Salman Hospital -Riyadh, 11- Jeddah Alsulimania PHC

We aimed to assess the effect of anemia on subjective sleep quality in patients with iron
deficiency anemia (IDA).
The present study is a prospective and cross-sectional study which has been carried out at King
Abdulaziz hospital between November 2016 and April 2017. Fifty-two patients diagnosed with iron
deficiency anemia and 40 healthy individuals, who are gender and age matched, were involved in the study.
All participants were requested to fill 3 forms: a socio-demographic form (age, gender, marital status, income
level and educational status), hospital anxiety and depression (HAD) scale and Pittsburgh sleep quality index
According to the HAD scale, the average anxiety score was found 9.31±2.41 in patients and 7.62±
2.11 in controls. And, the average depression score was 7.49±2.08 in patients and 6.39±2.73 in controls. The
total sleep quality score was 6.68±2.99 in patients and 4.27±1.71 in controls. There was a statistically
significant difference in terms of anxiety, depression and sleep quality scores. Linear regression analysis
showed no association between anxiety and depression with poor sleeping.
IDA affects sleep quality irrespective of psychological symptoms such as depression and
Iron deficiency anemia, sleep quality, anxiety, depression.


After a negative iron balance in the body as a
consciousness and behavior (6). It is defined as a
result of increased iron demand, chronic blood loss,
reversible state where interaction of the organism
and absorption disorder, hemoglobin synthesis is
with the environment is lost temporarily, partially
compensated by mobilization of iron from stores
and periodically. Almost 30­33% of the society has
and when the stores of iron fail to release adequate
a significant sleep problem. The said ratio is higher
iron, iron deficiency anemia (IDA) develops (1). Just
in older adults, those having a psychiatric disorder
like in KSA, iron deficiency is the most common
and specific groups with learning difficulties (7, 8). In
cause of anemia in the world and is more prevalent
numerous studies, stress, advanced age, depression,
in women than men (2, 3). It has been known that
female gender, alcohol, anxiety, substance abuse
more than 30% of those attending to hospitals in
and physical diseases are the main factors causing
developed countries are anemic and the said ratio is
sleep disorders (9).
much higher in developing countries(3).
As a result of the key role of iron in the
In developed countries, 3% of adult males, 20%
metabolism of monoamines in the brain and the role
of adult females and 50% of pregnant women have
of the same monoamines in sleep physiology, we
iron deficiency anemia (4). Loss of appetite,
specified that sleep quality might deteriorate in IDA.
tiredness, lethargy, pale skin, headache, tinnitus and
In this context, studies regularly have been
impairments in cognitive and intellectual functions
performed in pediatric populations. Therefore, we
can be perceived in IDA. Iron plays a key role in
intended evaluating sleep quality in adult patients
the metabolism of monoamines in the brain,
diagnosed with iron deficiency anemia.
accordingly, iron deficiency leads to symptoms, for

instance, drowsiness, apathy, irritability and lack of
attention arise as a result of impaired monoamine
The present study is a prospective and cross-
oxidase activity (5). Patients affected from iron
sectional study which has been carried out at King
deficiency display many behavioral and emotional
Abdulaziz hospital between November 2016 and
signs and have symptoms comparable to the ones in
April 2017. Fifty-two patients diagnosed with IDA
depressive individuals. Sleep is the period of
and gender and age matched 40 healthy individuals
physiological, periodic and reversible changes in
were involved in the study. Loss of appetite and
Received: 18/12/2017 DOI: 10.12816/0044545
Accepted: 28/12/2017

Full Paper (vol.707 paper# 17)

c:\work\Jor\vol707_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1174-1184

Risk Factors of Coronary Heart Disease among Medical Students in
Almaarefa Colleges, Riyadh, Saudi Arabia
Leejin Saleh Bin Kleib*, Atheer Abdullah Alhoshan,
Abdulmajeed Mohammed Alolayah
Almaarefa Colleges, Riyadh, Saudi Arabia
*Corresponding author: Leejin Saleh Bin Kleib, E-Mail: Lujain-93@hotmail.com, Phone: +966556002300

Nowadays, cardiovascular diseases (CVDs) represent an escalating worldwide public health
problem. Providing consistent data on the magnitude and risk factors of cardiovascular diseases (CVDs) among
young population will help in controlling the risks and avoiding their consequences.
Objective: The objective was to estimate the prevalence of risk factors of coronary heart disease (CHD) among
medical students during their clinical clerkship (4th-6th years).
Methods: A cross-sectional study was done during the educational year 2016-2017 at Almaarefa Colleges.
Ethical standards were follow and a multistage stratified random sample method was used for selection of 214
medical students. Data was collected through an interviewing questionnaire, measurements and laboratory
investigations. Both descriptive and analytical statistics were done by SPSS version 21. Coronary heart disease
(CHD) risk percent in thirty years was calculated using Framingham algorithm for each student, then the risk
among all students was determined.
Results: The commonest risk factors of coronary heart disease (CHDs) were daily intake of high fat diet (73.4%),
physical inactivity (57.9%), overweight/or obesity (31.2%) and daily consumption of fast food (13.1%).
Hypercholesterolemia (17.2%) and hypertension (9.3%) were also prevalent risk factors. Smoking prevalence was
low (2.8%). Males had significantly higher mean scores for most of coronary heart disease (CHD) risk factors
compared to females (p < 0.05). Systolic Blood Pressure was higher among males (119.47 ± 11.17) compared to
females (112.26 ± 9.06). A highly statistical significant difference was present (Students test = 4.74, p < 0.001).
Framingham Risk Score revealed that coronary heart disease (CHD) risk percent in thirty years among all
students was 10.7%, 2.3% and 0.5% for mild, moderate and severe risk, respectively.
Conclusion: An alarmingly high prevalence of coronary heart disease (CHD) risk factors was prevailed among
medical students, especially among males. However, a low prevalence of smoking may indicate the success of
"Smoke-free Campus" program. Screening risk factors of coronary heart disease (CHD) among medical students
and implementation of intervention programs are recommended. Programs to raise awareness about coronary
heart disease (CHD) risk factors, encourage young adult students to adopt a healthy dietary behavior and promote
physical exercise should be initiated.
Keywords: risk factors, coronary heart diseases, young adults, framingham risk score.

(KSA) is experiencing an alarming rising in
Non-communicable diseases (NCDs) are on
incidence and death rates from cardiovascular
continuous rise worldwide (1). Furthermore,
diseases (CVDs) (3-5). A study done in the Eastern
developing countries is experiencing a double
region of KSA revealed that 26% of total deaths
burden of diseases; both communicable diseases
were attributed to cardiovascular diseases (CVDs)
(CDs) and non-communicable diseases (NCDs) (2). It
(27% of deaths of males and 23.5% of females) (5). It
is estimated that in the developing countries non-
is expected that the burden of cardiovascular
communicable diseases (NCDs) will account for
diseases (CVDs) will continue to grow in KSA due
seven of each ten deaths by the year 2020. Among
to continuous exposure to risk factors. This increase
non-communicable diseases (NCDs), cardiovascular
is also considering the young population; as about
diseases (CVDs) are the leading cause of morbidity,
60% of the Saudi populations was less than 30 years
disability and mortality worldwide (1). The global
(4). Coronary heart disease (CHD) is the commonest
rise in cardiovascular diseases (CVDs) is driven by
cause of death from cardiovascular diseases (CVDs).
both urbanization and its related lifestyle
In addition, it is one of the leading causes of disease
modifications (3). The Kingdom of Saudi Arabia
burden (5). Identification of risk factors contributing
Received: 18/12/2017 DOI: 10.12816/0044546
Accepted: 28/12/2017

Full Paper (vol.707 paper# 18)

c:\work\Jor\vol707_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1185-1189

The Extent of Knowledge and Awareness of Prostate Cancer
Screening Among Saudi Men Aged More Than 40 Years
Abdulrhman Ahmed A Ghunaim 1, Hosam Salah Aljohani1, Yasir Abdullah Alharbi1, Abdulhalim Bakr
Hafizallah1, Alhasan Mohamed Abduldaem1, Mazen Mahmoud Abu Alhuda Kain1, Abdullah Ahmed A
Ghunaim2, SalehAbdulazizAbubaker3,Lian Mohammed Abbas Sharbatly4, Omar Oudah A. Aljohani5,
Ahmed Saleh Allohidan6
1Department of SHO, College of Medicine, Taibah University, Al-Madinah Al-Munawwarah,
2Medical Student, College of Medicine, Taibah University, Al-Madinah Al-Munawwarah,
3 Department of SHO, College of Medicine, Imam Muhammed ibn Saud Islamic University,
Riyadh,4Department of SHO, College of Medicine, King Abdulaziz University, Jeddah,
5Emergency Department, Ohoud General Hospital, Al-Madinah Al-Munawwarah,
6 Department of SHO, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Corresponding author: Abdulrhman Ahmed A Ghunaim, email: dr.abdulrhmang@gmail.com

Prostate cancer is a serious health problem that is very common among men aged more than 50
years. In 2012, the age standardized incidence rate of prostate cancer in Saudi Arabia was 4.5/100,000.Screening
of prostate cancer with prostate specific antigen (PSA) can help in early detection of prostate cancer which will
eventually lead to more appropriate treatment and less mortality. The rate of PSA screening is almost twice
among individuals with good knowledge compared to those with poor knowledge. The current study was
conducted to assess the awareness level about the importance of prostate cancer screening among men aged more
than 40 years in Saud Arabia.
This study was conducted to assess the awareness level about prostate cancer screening among Saudi
men aged more than 40 years.
Subjects and methods: This was a cross-sectional study. An anonymous web-based questionnaire about
demographic characteristics in addition to participants' knowledge in relation to prostate cancer vaccination was
filled by 328 adult men from Saudi Arabia.
Less than 30% of the participants gave correct answers about the age at which prostate cancer screening
should be done. The level of knowledge was found to be affected by several factors including age, marital status,
occupation, educational level and family history of cancer. In addition, periodic visits to healthcare center to
undergo examination and discussion with clinical doctors were found to positively affect participant's knowledge.
It's very important to ensure a high level of awareness of prostate cancer screening among adult men
in order to allow early detection and more efficient treatment in Saudi Arabia.
Prostate cancer, Screening, PSA, Knowledge, Saudi Arabia.

Globocan data states that the incidence of
Prostate cancer is a serious health problem that is
prostate cancer in the Middle East will increase
very common among men who are aged more than
from 29,377 (new cases) in 2012 to 38,562 (new
50 years and it reaches its peak at the age of 70
cases) in 2020. This will be associated with
years in majority of the cases1.
increased mortality rate from 15,422 death cases in
There are variations between the incidence and
2012 to 19,681 death cases in 20204.
prevalence rates of prostate cancer in Arabic,
Screening of prostate cancer with prostate
Eastern and Asian populations. The United States
specific antigen (PSA) can help in early detection
and Canada have the highest incidence rates
of prostate cancer which will eventually lead to
followed by Europe. While the incidence rate is
more appropriate treatment and less mortality5.
lower in Asian countries especially Arabic
Moreover, the rate of PSA screening is almost
twice among individuals with good knowledge
In 2012, the age standardized incidence rate
compared to those with poor knowledge6.
(ASIR) of prostate cancer in Saudi Arabia was
A review article on Prostate cancer in Saudi
4.5/100,000 with the highest rates reported in
Arabia in suggested that increased awareness of
Riyadh region and the Eastern region. This is
the disease will lead to diagnosis at early stages
significantly lower than the incidence rate among
and improvement of health care7.
European and Gulf countries3.
It has been shown that worldwide media
campaigns on prostate cancer associated morbidity
Received: 18/12/2017 DOI: 10.12816/0044547
Accepted: 28/12/2017

Full Paper (vol.707 paper# 19)

c:\work\Jor\vol707_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1190-1195

Awareness of Diabetic Complications, Perceived knowledge, Compliance to
Medications and Control of Diabetes Among Diabetic Population of Makkah City,
Kingdome Saudi Arabia: Cross-Sectional Study
Ensaf Mohammad Fatani1, Lujain Nasserallah Gari1, Anwar Hameed Alharbi1, Jawaher Ali
Alzahrani1, Asma Salem Almasoudi1, Eman Suliman Bablghaith1, Amal Joiber Alsaedi1, Ruqayah
Marzouq Alkhusayfi1, Abrar Faleh Albarakati1, Somaya Khalid Alsharif11
1 Medical Intern, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia

According to World Health Organization (WHO) in 2012, an estimated 1.5 million deaths were
a direct outcome to diabetes and another 2.2 million deaths were attributively related to high blood glucose in a
global population. As a consequence, researches confirmed that diabetics have a shorter life expectancy than
non-diabetic individuals and this extravagant mortality is predominantly due to diabetic complications.
Methods: We have conducted a descriptive cross-sectional study on Makkah Region population, Saudi
Arabia. All Saudi patients diagnosed with DM, regardless the type, and living in Makkah regions were
included in this study. The total sample obtained was 299 patients. A self-administered questionnaire, about
knowledge of diabetes mellitus complications, was filled by participants.
Results: Participants were classified into five categories according to age. Male and female groups percent
was (39.1%) and (60.9%) respectively. Nearly two thirds of participants have the disease for more than five
years (63.2%), and nearly two thirds were compliant to their medications (62.5%). Three quarters of
participants (76.9%) had positive family history of diabetes mellitus. (26.1%) of participants had only one
family member with diabetes mellitus, (16.7%) had two members, and (14.7%) had five members or more with
diabetes mellitus.Conclusion: To develop effective patient education and improve patients' diabetic control
and own complications, educational strategies are needed so as they may help diabetic patients to improve self-
knowledge and recognition of early signs and symptoms of DM complications, and this will prevent further
deterioration, which will improve life quality and increase life expectancy for those patients.
Keywords: diabetes mellitus, awareness, complications


60, taking into account early deaths. In 2015, Saudi
Diabetes mellitus (DM) is considered to be one of
Arabia had 23,420 deaths in adults due to diabetes[2]
the main 4 groups of Non-communicable diseases
. According to World Health Organization (WHO)
(NCDS) which are the biggest cause of death
in 2012, an estimated 1.5 million deaths were a
worldwide. More than 36 million die annually from
direct outcome of diabetes and another 2.2 million
NCDs (63% of global deaths) where diabetes
deaths were attributively related to high blood
account for 1.5 million NCDs deaths annually. While
glucose in global population[3] . As a consequence,
its complications can lead to cardiovascular disease,
researches confirmed that diabetics have a shorter
cerebrovascular disease, retinal disease, renal disease
life expectancy than non-diabetic individuals and
and lower limb amputation. Limited data is available
this extravagant mortality is predominantly due to
regarding the awareness and knowledge about these
cardiovascular cause which considered one of the
complications in our population[1] . According to
interminable diabetic complications[4]. Another study
International Diabetes Federation (IDF), Saudi
confirmed the virtually higher risk of death, minimal
Arabia had 3.4 million cases of diabetes in 2015
survival, and lower life expectancy of diabetic adults
(Prevalence of diabetes in adults aged 20-79 years is
in comparison to non-diabetic adults[5]. DM is
17.6%). It is estimated that 415 million people have
considered a lifelong problem; but with the proper
diabetes in the world while more than 35.4 million
management; the quality of patient's life can be
people (9.1% of adults aged 20-79), are in the
improved noticeably. Thus individual training is an
Middle East and North Africa (MENA) Region. It is
integral part of self-management of diabetes. In
anticipated by the year 2040 this will rise to 72.1
conclusion optimum management requires patient
million. Over 40.6% of these are undiagnosed.
participation and cooperation to be aware of the
Health expenditure on diabetes in the region
nature of the disease and therefore decide the
accounts for just 2.5% of global spending on the
consequence of the disease, dimensions of treatment
disease. This is expected to almost double by 2040
and its complications[6, 7]. This study was performed
but will likely not be enough to adequately treat all
to evaluate awareness and recognition of the signs
people with the disease. Regarding mortality,
and symptoms regarding diabetic complications
diabetes was responsible for 342,000 deaths (51.3%)
among Makkah population, and to calculate the
in 2015 which occurred in people under the age of
frequency of diabetic complications occurrence.
Received: 25/10/2017 DOI: 10.12816/0044548
Accepted: 05/11/2017

Full Paper (vol.707 paper# 20)

c:\work\Jor\vol707_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1196-1200

Divorce Rates among Cancer Patients ­ A Saudi Arabian Study
Saeed M. Alzahrani1*, Abdulaziz A. Albalawi1, Abdulaziz R. Alshehri1, Hatim M. Al-Jifree2
1 King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health
Sciences,2Gynecology Oncology Consultant -Princess Noura Oncology Center-MNGHA
*Corresponding author: Saeed Musfer Alzahrani, E-Mail: Saeed.z@live.com, Phone: +966560450007

divorce has been a serious problem of major prevalence in our community. According to
Saudi Ministry of Justice, divorce rate was estimated to be 27.84% in 2015. Therefore, this study aimed to
obtain the incidence of divorce among cancer patients in Princess Noura Oncology Center to know whether
being diagnosed with cancer would affect the marital status in terms of divorce.
Patients and Methods: the study included 125 patients with age of 15-70 years, have been married, and
diagnosed with cancer. Patients were interviewed in the clinic. For data analysis, we used SPSS. Institutional
Review Board approval was obtained.
Results: divorce rate among cancer patients was significantly lower than that of the general population (P
value <0.001). It was found to be higher in patients with breast cancer 50%, followed by non-solid tumor
33% of all divorces. 66% of divorced cancer patients were females.
Conclusion: divorce rate in cancer patients is lower than that of the general population. Therefore, we
believe that cancer has led to stronger relationships. Cancer by itself does not increase the rate of divorce.
Interestingly, it is generally found to be higher in female patients and breast cancer.
Keywords: Cancer, Marriage, Divorce, Saudi Arabia, Marital status.


difference in divorce rates between cancer survivors
Divorce is a serious social problem that is
and the general population. Taken together, these
prevalent in the Saudi Arabian community. The
studies imply that the effect of a cancer diagnosis
psychological burden of divorce can have a serious
on marital status is complex and likely to be
impact on all aspects of an individual's life. Cancer
alone has serious consequences on a patient and
Other studies have found a correlation between
his/her family members (1).
the increased divorce rate and specific cancer types
Cancer patients frequently suffer psychological
such as cervical cancer and brain tumors (3, 4).
trauma due to their chronic and devastating
Other studies have suggested links between marital
condition (1). The disease can cause tremendous
status and cancer outcome; for example, Ben-
changes to a patient's lifestyle, which in turn may
Schlomo et al. (6) revealed an increased risk of
significantly affect the lifestyle of his/her partner.
overall mortality in unmarried patients. In addition,
We thus sought to investigate whether this
they found that being divorced increased the risk of
psychological trauma could lead to divorce or
cancer mortality among male patients.
separation among cancer patients in Saudi Arabia.
Therefore, this study aims to determine divorce
To date, studies to examine the impact of cancer
rates among cancer patients who were treated at the
on marital status have not been conducted in Saudi
Princess Noura Oncology Center (PNOC).
Arabia, although they have been conducted in other

countries (2, 3). One study analyzing young adult
cancer survivors concluded that subjects were at a
The questionnaire
higher risk of divorce or separation due to the
We designed a questionnaire-based cross-
financial and emotional burdens of their condition
sectional study, which consisted of three primary
(1). Another study, of the long-term survivors of
components: patient demographics, cancer status,
childhood cancers that was derived from the
and marital status. The questionnaire also included
Childhood Cancer Survivor Study (CCSS), showed
a formal consent statement that explained the nature
that the divorce rate among cancer patients was
and goals of our study to the patient. Our
most pronounced in black male patients (2). Studies
questionnaire was reviewed and approved by the
have also suggested disparity in divorce rates
King Abdullah International Medical Research
between male and female cancer patients; Twombly
Center, together with a social worker and an
(4) demonstrated an eight-fold increase in separation
oncologist working at the PNOC.
and/or divorce incidence among female brain tumor
Participants and recruitment
patients compared to male patients. Conversely; a
Patients (n=125) were randomly sampled from
French study (5) concluded that there was no
cancer patients that were currently, or had
Received: 19/12/2017 DOI: 10.12816/0044549
Accepted: 29/12/2017

Full Paper (vol.707 paper# 21)

c:\work\Jor\vol707_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1201-1208

Evaluation of Awareness and Attitudes towards Common Eye
Diseases among the General Population of Northwestern Saudi Arabia
Wareef A. Al-Lahim, Reema S. Al-Ghofaili, Hyder Mirghani, Hani ALBalawi
Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
Corresponding author: Wareef A. Al-Lahim,P.O. Box 71471,E-mail :allahim.w@gmail.com

Background: assessing of the population's awareness concerning eye diseases would provide a fundamental
basis and acts as a future reference to executing such health promotion initiatives.
Objective: this study aimed to evaluate the public awareness and attitudes towards common eye diseases in
Tabuk, Saudi Arabia.
Materials and Methods: this cross-sectional study was conducted in Tabuk, Saudi Arabia during the period
from June 2017 to December 2017. A convenient sample of 397 participants of adults aged above 18 years old
was chosen by a stratified method. A self-administered online survey included multiple choice and true-false
questions was used to obtain information about respondent's awareness regarding common eye diseases
including cataract, refractive errors, glaucoma and diabetic retinopathy.
Results: 77.6% of participants were females, 41.4% were between 18 and 25 years, 52% of the respondents
had sufficient knowledge regarding common eye problems. The most frequent sources of information were the
internet (46.7%), relatives (38.5%) and mass media (35.4%). The participant's knowledge ranged from
66.3%for the cataract to 36.3% for refractive errors. Only educational level and job were significantly
associated with knowledge about refractive errors. The majority of the respondents (75%) reported visiting
ophthalmologists only when they have complaints and just 10% of them visited ophthalmologists regularly.
When they had eye problems, almost two-thirds visited the ophthalmologist directly whereas 9% and 7.4% of
them did nothing or depended on home therapy, respectively.
Conclusion: awareness and knowledge of adult population in Tabuk, Saudi Arabia is suboptimal. Health
education campaigns are needed to improve their knowledge and protect them them from adverse
complications of these diseases.
Keywords: knowledge, cataract, glaucoma, refractory errors, diabetic retinopathy.


Visual impairment represents one of the
could be affected by various factors such as age,
pivotal health issues of the public with an estimated
gender, education level and socioeconomic status (3).
253 million people are suffering worldwide, of
As reported by Waleed A et al. older people and
which 36 million are blind. The two most leading
females were more knowledgeable (5).
causes are uncorrected refractive errors and then un-
Implementation of campaigns and community-
operated cataract(1).
based education programs is an influential element
People who are older than 50 years constitute
of eye health promotion strategies (1). Moreover, it is
more than 80% of visually impaired individuals.
believed that it will not only help in raising
Furthermore, the prevalence of diseases with a
awareness, but also encourages the community to
potential effect on the eye such as diabetes mellitus
take liability towards its eye health as well as
sustain a tremendous increase which puts more
employing available eye care services appropriately
people at a higher risk of having conditions like age-
(2). In the light of what was previously mentioned,
related macular degeneration, diabetic retinopathy
assessing the extent of the population's awareness
and glaucoma (1,2).
concerning eye diseases would provide a
Fortunately, vision impairment can be
fundamental basis and act as a future reference to
prevented or cured in almost 80% of conditions (1).
execut such health promotion initiatives.
However, insufficient awareness about sight-
Seldom studies have been published describing
threatening eye diseases may contribute to the delay
knowledge, attitude and practices associated with
of seeking medical advice and losing the
eye diseases among the general population of Saudi
opportunity of timely interference and prevention
Arabia (5,6). Up to our knowledge, no such study
(3). Indeed, increased awareness of these conditions
addressed this issue among people of Tabuk city.
will likely promote effective management and
Thus, the purpose of our study was to evaluate
consequently result in minimizing the burden of
the public awareness and attitudes towards common
visual impairment and expense of eye care (4).
eye diseases such as glaucoma cataract, diabetic
Level of awareness regarding ocular diseases
Received: 19/12/2017 DOI: 10.12816/0044550
Accepted: 29/12/2017

Full Paper (vol.707 paper# 22)

c:\work\Jor\vol707_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1209-1220

Incidence of Child Abuse and Parents Role in Riyadh, Saudi Arabia
Afnan Abdullah Alghamdi, Youssef Fayez Horaib, Rehab Mohammed ALdossari,
Ghady Ibrahim Alhayazea, Waad Khalid Almusailhi
Almaarefa Colleges, Riyadh, Saudi Arabia.
*Corresponding author: Youssef Fayez Horaib, Email: yfh-1990@hotmail.com , Mobile number: +966566441981

child abuse is a worldwide problem that affects seriously the health and welfare of children. Parents
have a key role to avoid or prevent the exposure of their children to abuse.
Objectives: this study was conducted to assess the awareness about child rights and the most important ways to
detect child abuse among the parents and to investigate the risk and protective factors associated with prevalence
rates and impact and the parents role in cases of abuse in Riyadh, Saudi Arabia.
a questionnaire was distributed among the general public in Riyadh City. The questionnaire consisted
of questions about socio-demographic data of the respondents, as well as other questions that explored the
awareness and knowledge about child abuse. The respondents were assorted into two groups according to total
knowledge score.
Results: respondents showed good knowledge of physical neglect, educational neglect, and physical abuse.
According to the respondents, the most common types of abuse in the community were emotional and physical
abuse; the most common risk factors were psychiatric illnesses and low educational level; the most common
perpetrators were strangers, drivers, house servants, classmates, teachers, fathers and mothers. A high percentage
of respondents did not know places that can help in dealing with abuse cases.
Conclusion: the respondents displayed a fair level of knowledge about the types of abuse, the most common risk
factors and the effective methods to protect the children against abuse. However, defects in their knowledge were
detected as regards what constitutes physical child abuse and where to seek aid if abuse is suspected.
Keywords: child abuse, battered child syndrome, child neglect, questionnaire.


that have an actual or potential risk of physical harm
Child abuse, or child maltreatment, represents a
of the child, such as hitting with a hand or any
violation of the childs basic human rights (1).
materials, punching, kicking, biting, shaking, or
Child abuse is estimated to be more prevalent than
burning (5). In some communities, corporal
previously thought. A quarter of all adults report
punishment is accepted as a justifiable method of
having been physically abused as children; while 1
child discipline (6), but serious body harm cannot be
in 5 women and 1 in 13 men report having been
excused as a method of discipline (4). Emotional
sexually abused as a child (2). Many definitions exist
abuse occurs when the caregiver fails in supplying
to describe child abuse (3). The World Health
supportive and appropriate environment for the child
Organization described child maltreatment as ,,,,all
(5). It usually manifests in the form of shouting the
types of physical and/or emotional ill-treatment,
child, belittling, cursing, leaving alone, frightening,
sexual abuse, neglect, negligence and commercial or
not meeting the psychological needs, making
other exploitation, which results in actual or
comparisons among the siblings, humiliating or
potential harm to the childs health, survival,
behaving so protective. Emotional abuse is
development or dignity in the context of a
commonly involved in other types of child abuse,
relationship of responsibility, trust or power(2).
but it may occur alone (5). Child sexual abuse
This definition included all forms of ill treatment
included any activity with a child, before the age of
that may result from commission (physical,
legal consent, that is for the sexual gratification of an
emotional, or sexual abuse), or those that may result
adult or a significantly older child. Sexual activities
from omission (neglect). Therefore, child abuse is
may include all forms of oral-genital, genital, or anal
discussed usually in literature under these four types
contact or child abuse that does not involve contact
such as exhibitionism, voyeurism or using the child
Neglect is the failure to provide necessary
in the production of pornography (7).
food, care, clothing, shelter, supervision or medical
Child abuse may not only affect the victims
care for a child (4). Physical abuse included all acts
shortly after the incident, but is responsible for
Received: 19/12/2017 DOI: 10.12816/0044551
Accepted: 29/12/2017

Full Paper (vol.707 paper# 23)

c:\work\Jor\vol707_24 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1221-1223
A Case Report of Partial Molar Pregnancy Associated with
A Normal Dizygotic Twin
Abdullah Abukaftah1, Sumirah Jabeen2, Abdullah Moawad 3, Metrek Almetrek4
1.Internship Department, College of medicine, King Khalid University, Abha, 2.Department of Obstetrics and
Gynecology, Armed Force Hospital Southern Region, Khamis Mushait, 3. Internship Department, College of
medicine, King Khalid University, Abha, Saudi Arabia,4.Joint Program of Postgraduate Residency Training
Program of Family Medicine in Khamis Mushait
Correspondence author: Abdullah Saeed Ahmad Abukaftah,Email: a.abukaftah@gmail.com

Partial molar pregnancy is an uncommon thing in which there is usually a triploid atypical fetus
accompanying with a large placenta with cystic changes. The incidence of a normal diploid fetus and a partial
molar placenta is really uncommon. Here we report a case of partial molar pregnancy in which a normal looking
fetus with diploid karyotype coexist. A focal placental abnormal region was noticed at 13 weeks of pregnancy
as enlargement associated with cystic changes. Fetus showed no clear deformity. Concerning these findings,
the patient continued her pregnancy under close observation and advanced sonographic evaluations were made
to rule out other differentials. There were no obstetric complications until the 28th gestational week when
vaginal bleeding occurred. The patient underwent caesarian section and the products were sent for
pathologic assessment which confirmed the partial molar changes.
Keywords: Molar Pregnancy, Normal Dizygotic Twin, Triploid atypical fetus.

patient and her husband and they decided to keep
A partial molar pregnancy is a variation of a molar
the pregnancy, then the patient was discharged after
pregnancy in which an embryo either not
two days.
completely developed or develops with many
At 25th weeks of gestation the patient came to
anatomical anomalies. In this type of abnormal
emergency room with lower abdominal pain and
conception, the egg typically receives two group of
back pain. On examination she was stable with
chromosomes from the father, because the egg
unremarkable findings and was admitted for
received two sperms. Instead of 46 the egg now
observation until delivery. Her beta-HCG was
has 69 chromosomes [1]. Most cases in which
106,000 mIU/mL and the ultrasound revealed
molar change has been recorded with presenting
molar pregnancy without visible embryonic tissue
of normal fetus represent a dizygotic twin's
with coexistent live fetus at 24th-weeks-old with
pregnancy containing complete hydatidiform mole
normal anatomy and posterior placenta.
and normal developing fetus with obviously
Patient received dexamethasone and cesarean
recognizable molar areas in the placenta [2]. We
section was planned with bilateral tubal ligation
present a case of partial molar pregnancy
(BTL) at 34th week if not indicated before. Consent
associated with a normal dizygotic twin.
of BTL was signed by the couple, then the patient

was discharged because she is living near the
hospital and there is good support at home. The
40 years old Saudi female gravida 6 para 4+1
high risk of live fetus to be with chromosomal
previous, 4 cesarean section medically free pregnant
anomaly and intrauterine fetal death or early
at 12 weeks of gestation came to emergency
neonatal death was explained to the patient and
department of King Faisal hospital in 21st of May
she was advised to come to emergency room if
2017 due to abdominal pain and mild vaginal
there is any complaint.
bleeding in the last night. On examination she was
At the 28th week of gestation the patient came to
hemodynamically stable and not in distress, with
emergency with vaginal bleeding and abdominal
fundal level of 13 weeks, ultrasound shows
pain. On vaginal examination the cervix was 2 cm
diamniotic dichorionic, single live fetus with Crown-
dilated and 60% effaced -3. Ultrasound showed
rump length = 5.4 cm with beating fetal heart. There
partial molar pregnancy with coexistent normal
was another partial molar pregnancy with remnant
anatomy live fetus at 26th week. The patient was
embryonic tissue and low placenta above the
shifted to an urgent cesarean section.
internal os with Swiss cheese appearance. This one
Lower segment cesarean section was done under
was lower than the living fetus (see figures below),
general anesthesia. A living male fetus was
labs showed beta-HCG 58,000 mIU/mL. The patient
delivered, with cephalic presentation with good
admitted for close observation because threatened
APGAR score, then the molar pregnancy sac was
abortion and the investigation findings and the risk
removed completely. It was grape-like with
of the case e.g. fetal death; were explained to the
vesicular tissue. A large amount of placental tissue
Received: 19/12/2017 DOI: 10.12816/0044552
Accepted: 29/12/2017

Full Paper (vol.707 paper# 24)

c:\work\Jor\vol707_25 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1224-1227

Pharmacist's Knowledge, Practice and Attitudes Toward
Pharmacovigilance and Adverse Drug Reactions
Attiah Abdullrhman Khobrani1, Mesfer Safar Almalki1,
Fakhir Thamir Alotaibi1, Hassan Abdullah Aljabri2
1Security Forces Hospital of Makkah, 2Alnahdi Medical Group

It is observed that the adverse drug reactions are one of the many reasons contributing in the
deterioration of health and wellbeing.
Objectives: This study was carried out to list the numerous elements affecting the knowledge, attitude, and
practice of pharmacists and pharmacy technicians towards pharmacovigilance and adverse drug reactions.
Material and methods: A certain prepared questionnaire is performed over numerous pharmacies from the
areas around in addition to the data collected from similar researches which performed the same method.
Results: Based upon the findings of our study, we came to a vision of the superiority of pharmacists over
pharmacy technicians when it comes to acknowledging how to deal with pharmacovigilance and adverse drug
Conclusion: Pharmacists are more knowledgeable when it comes to ADRs than pharmacy technicians, yet both
of them needs to go under training for enhancing their knowledge.
Keywords: KAP, ADR, Adverse drug reactions, pharmacovigilance.


It has been noticed that the adverse drug
effects. That is why it comes down to the
reactions "ADRs" are considered to be of the many
community pharmacists and pharmacy technicians to
reasons contributing in the deterioration of the health
know those effects. The importance of discovering
and wellbeing of certain cases in hospitals and
such effects is actually crucial in the work of
treatment centers leading to losses of mortality and
hospitals and health centers. And that is referred back
abnormality type (1).
to the contribution of the ignorance of ADRs in
On the other hand, the world health organization
increasing of the hospitality time spent by the
"WHO" identifies the pharmacovigilance as the part
patients inside the health care center, which of
of science, which is, interrelated with inspection,
course, leads to greater consumption of resources (4).
evaluation, and countermeasure the effects of any
That is why an instant reporting of the effects of
drug causing problems. It is a very important and
ADRs is something really crucial and helpful for the
significant branch of sciences, because it can
pharmacists themselves doing so, or for the health
contribute in the development of hospitals and
care organizations like hospitals and health centers. It
making them consume and lose less resources and
provides a faster and statistical information delivery
energy in favor of the deceased and abnormal cases
concerning the effect appeared as a symptom on the
patient with the least cost of experimentation for
It is pretty observable that community
discovering so possible (5).
pharmacists are the ones most closest to the ADRs
There are a lot of pharmacovigilance centers
effect on patients every day, that is because of the
built across the whole world in difference of
nature of their work with patients and their multiple
numbers, facilities, and technologies to help form a
conditions which involve them in their beginning and
concrete image about the ADRs effects in every drug
passing through the entire process of pathological
possible to get reported about (6).
effects and symptoms appearing on them. Finally,
They mostly use the data collected from the
ending up with final treatment suitable for every
community pharmacists in their area, in addition to
condition whether that knowledge was collected
the data collected from the other experimentation
from the patients themselves and their experiments or
they run and conduct in many aspects to study every
from the scientific reference (3).
angle of effect of the drug being tested (7).
FDA as an organization when approves a certain
The knowledge is important, and to show how
drug, there is very little information about its adverse
important and significant it is for such field, we need
Received: 19/12/2017 DOI: 10.12816/0044553
Accepted: 29/12/2017

Full Paper (vol.707 paper# 25)

c:\work\Jor\vol707_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1228-1229

Late Presentation of Neuroblastoma with Brain
Metastases: Critical Care Case Report
Turki F. Alharthi, Sami D. Althobiti , Abdulrahman D. Alsufyani
Medical Intern, Taif University School of Medicine, Taif, Saudi Arabia.


Aim of the work: neuroblastoma of the adrenal gland is an extremely rare tumor in adulthood although it is one
of the most common malignancies in childhood. Patient and method: a case of 14-year-old Saudi girl
developed brain metastases after neuroblastoma mass resection. Results: the patient received Multi-agent
chemotherapy and the condition of patient was improved. Conclusion: chemotherapy may provide good
prognosis in treating neuroblastoma.
neuroblastoma, brain metastases, ICU, critical care.

38°C (orally), blood pressure of 95/70 mm Hg,
Neuroblastoma is tumor of the autonomic
upward gaze, generalized tonic colonic movement of
nervous system with an embryonal origin, meaning
upper and lower extremities. Initial magnetic
that the cell of origin. neuroblastomas generally
resonance imaging showed cystic mass measured
occur in young children; the median age at diagnosis
27×13 mm in the left occipital lobe with rim
around 17 months(1).
enhancement and 12×8 mm enhancing mass in
Tissues of the sympathetic nervous system are
periventricular of the left lateral ventricle was
the main site tumor arise from, mostly in the
detected. In addition, another heterogeneous signal
paraspinal ganglia or adrenal medulla; tumor could
intensities lesion measured 11×9 mm adjacent to the
be found as mass lesions in the neck, chest,
right superior cerebellar peduncle and multiple
abdomen, or pelvis with variable clinical
enhancing nodules in cerebrospinal fluid (CSF)
presentations, ranging from asymptomatic lesion to
space were noted. The above findings were in favor
critical illness as a result of local invasion,
of cerebrospinal fluid and brain parenchymal
metastatic, or both. The incidence of neuroblastoma
metastasis. Neurosurgery was done for her and
is 10.2 cases per million children below 15 years of
drainage of large lesions was done. Bone marrow
age and it is the commonest tumor diagnose at first
aspiration showed sheets of monotonous small round
years of life (1).
blue cells and revealed metastatic spreading to this

site. CSF cytology was positive for malignancy
(Metastasis). The patient received Multi-agent
14-years old Saudi girl with no significant
chemotherapy by combinations of Irinotecan and
medical history, was presented to ER with
cyclophosphamide and the condition of patient was
generalized bone pain, low-grade fever and
fatigue, 2 years ago diagnosis was made of
The study was done after approval of ethical
neuroblastoma in the adrenal gland. Two separate
board of Taif university.
abdominal surgery were done for mass resection and

chemotherapy was giving according to local
protocols. She was resistant to chemotherapy and the
Neuroblastoma is the most common extracranial
solid malignant tumor of childhood. 65%of
refractoriness. Patient admitted to intensive care
abdominal tumors found in the adrenal medulla the
unit(ICU) and here condition getting worse with
most frequent location for neuroblastoma is the
generalized tonic colonic convulsion and decreased
level of consciousness. Physical examination
abdomen. 15% are usually arising of thoracic origin
revealed an unconscious patient with temperature of
from the sympathetic chain of the posterior

mediastinum(2). Neuroblastoma is extremely poor

prognosis, not significantly affected by either
radiation or chemotherapy if undetected during the
Received: 19/12/2017 DOI: 10.12816/0044554
Accepted: 29/12/2017

Full Paper (vol.707 paper# 26)

c:\work\Jor\vol707_27 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1230-1233
Awareness of School Teachers about Diabetes Mellitus
Rayan Mohammed Almehmad1, Sattam Abdullatif Bin Qadir2 , Khalid Mohammed Taweel 3,
Majed Abdulkarim Marouf2, Abdullah Hasan Algarni 2, Basim Mohamad Qadah 2
1-Security Forces Hospital, 2-King Abdulaziz Hospital, 3-King Fahad Hospital
Diabetes mellitus was defined by World health Organization as a metabolic disorder which
characterized by chronic hyperglycemia. It is a disease with several etiologies. It is one of common diseases
in children. School children with diabetes need special care while they are in school as they may experience
problems in glucose levels or other problems. Teachers are persons responsible for children in school, so they
should have adequate information and good level of awareness about diabetes to deal with diabetic children
especially in emergency case.
Aim: To assess the awareness of school teachers about diabetes.
Methods: This cross-sectional study was performed in the period between October 2017 and November 2017
on school teachers in Makah region using a questionnaire. Data were analyzed by SPSS program.
Results: There were 58.4% males and 41.6% females in this study, the correlations between level of
knowledge and different variables were as follow; the age of teachers significantly (P-value=0.009) affected
the level of awareness, where teachers with older age (50 years) had the highest awareness among other
participants, while those with age 40-49 years were the dominant group to have both moderate 30 (58.8%)
and low awareness 20 (39.2%). Gender also was a significant factor that affected the level of awareness (P-
value=0.004), where males 23 (33.8) had high level of awareness than females 3 (12.6%).
Conclusion: There was moderate level of knowledge about diabetes among school teachers. Age, gender,
level of education and monthly income affected the level of knowledge.
Keywords: DM awareness, School Teachers, Saudi Arabia.


Diabetes mellitus is a metabolic disorder in
Diabetes has psychological and physical effect
which there is a defect in the function of B-cell that
on the affected children [11]. Teachers are the main
located in the pancreas, this in turn results in insulin
care-giver for school children [12] and they are the
defection, so the level of glucose increases [1]. The
first line for their protection [11]. They should deal
highest prevalence rates of diabetes are concentrated
very carefully with emergencies of children [13]. It
in North Africa and Middle East [2]. Diabetes is a
was demonstrated that there was a role for teachers
challenging problem that Saudi Arabia faces [3], and
in assisting the diabetic school children in their
there is a rising in diabetes prevalence in Saudi
special needs [14, 15]. It was reported that there was
Arabia [4]. it was reported that diabetes mellitus
inadequate understanding of diabetes among the
reached to 3.4??? cases in Saudi Arabia in 2015 as
majority of school personnel [16, 17]. Other studies [12,
reported by international diabetes federation [5].
18] reported that teachers had poor level of
There are several risk factors for diabetes
knowledge about diabetes and its management and
development including; obesity, eating behavior,
there was a fundamental lack of understanding of
physical activity [6] and socioeconomic factors [7]. In
child health issues. Also, it was reported that 25% of
school age children, diabetes is one of the most
teachers had insufficient understanding of diabetes
common disorders among them [8]. It was stated that
and low knowledge about the recognition and
type I diabetes affected 440,000 children in 2006
treatment of emergency problems in diabetics [19].
whose age was under 14 years old [8]. Diabetes can
So the aim of this study was to assess the awareness
result in critical complications such as problems
of teachers about diabetes in Makah region.
with eyes, bones and joints, teeth and gums, blood

vessels, kidneys, nerves, skin and feet [9].
Complications of diabetes can be delayed or
Study design and subjects
prevented by good management and control [9].
The present study is a cross sectional study which
Knowledge is a factor that derives individuals for
was conducted on teachers in Makah, Saudi Arabia
certain behavior. Gap in health knowledge can
in the period from October 2017 to November 2017.
cause health problems [8]. School students with
The study based on a survey consisted of 32
diabetes need knowledgeable personnel to help
questions, this survey was distributed between
them in controlling and managing their diabetes
participants. The survey included two parts, the first
while they are in school and practice their daily
one to investigate demographics of teachers and the
activities [10], as they need special health care [11].
second part to investigate awareness of participants.
Received: 19/12/2017 DOI: 10.12816/0044555
Accepted: 29/12/2017

Full Paper (vol.707 paper# 27)

c:\work\Jor\vol707_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1234-1237

Community Pharmacists' Knowledge, Attitude and Practices towards
Dispensing Antibiotics without Prescription (DAwP)
1Fakhir Thamir Alotaibi, 1Attiah Abdullrhman Khobrani, 1Mesfer Safar Almalki,
2Hassan Abdullah Aljabri
1Security Forces Hospital of Makkah, 2Alnahdi Medical Group

As a result of the wide antibiotic abuse in many communities all over, bacterial resistance against
different antibiotic formulas has aroused. It is an actual matter of importance because it touches up the most
crucial principles of pharmacy and devoted work for medicine field in general.
Objectives: We have come to the aim of assessing the knowledge, attitude, and practice of pharmacists
concerning dispensing antibiotics without prescription. We are discussing the ethical and legal elements
contributing in the judgment of the final results and decision about the matter.
Material and methods: We are using the questionnaire test method to assess the knowledge and measure the
attitude and practice of those pharmacists in marks and degrees.
Results: the pharmacists working in community pharmacies lack the knowledge of the legality of DAwD,
though they know the greatly bad influence of it over the resistivity in bacteria and viruses. That of course goes
along with the knowledge degree of the patients themselves
Conclusion: We have come to a conclusion that most of the pharmacists had no prior knowledge of the illegality
of dispensing antibiotics without prescription "DAwP". And of course, we recommend to enhance the awareness
and knowledge of them by raising educational training programs.
Keywords: Pharmacists, KAP, bacterial resistance, DAwP, knowledge, attitude, practice.


It is now a worldwide problem of the century that
Several studies were conducted and many
there is a common bacterial resistance against
campaigns were run to aware the people of the danger
antibiotics from different formulas. And the reasons
of over-using antibiotics without a proper prescription
behind that phenomena are taken into studying. It is a
signed by an approved doctor of a certified
really dangerous matter, even beyond what we could
professionalism. The studies then were conducted
possibly imagine (1).
once more to identify and measure the knowledge,
The dangers behind such phenomena may reach
attitude, and practice of pharmacists and patients after
to the point where antibiotics have no good dealing
being exposed to the campaign concerning DAwD.
with bacteria, which leads to longer diseases
And that was in the purpose of defining the impact of
symptoms and higher rates of deterioration of the
those campaigns on the social, and medical level (4).
body accompanied with a great number of mortalities
The world health organization "WHO" could be of
and losses. It all goes back to the excessive usage of
proper help when they offered answers to the
antibiotics without following a proper prescription
questions raised by the results and the findings of
assigned by a professional doctor who had looked
previous studies statistics for deteriorated cases
into the diagnosis of the case really well to prescribe
because of over usage of antibiotics without
such drug eventually. This participated in the
prescription. The answers were interrelated with
adaption of bacteria to different kinds of antibiotics
easing up the way for reaching the medical facilities
available in our drug stores and scientific centers in
concerned with proper prescription. Also, they stated
medicine (2).
that we need to cut off any non-essential usage of
It was, after all, meant to look into the factors
anti-bacteria and anti-microbes to decrease their
affecting the intense usage of antibiotics without
activity and resistivity to antibiotics and drugs
prescription from the side of the pharmacists or the
fighting them. Finally, they stated that we must
doctors themselves. A various elements put into
follow a complete course of treatment when dealing
consideration, like the knowledge, attitude and
with antibiotics in order to overcome bacteria at once
practice of the pharmacists and patients towards those
without leaving any dosage behind, because that
drugs (3).
might lead bacteria to learn to adapt and resists that
Received: 19/12/2017 DOI: 10.12816/0044556
Accepted: 29/12/2017

Full Paper (vol.707 paper# 28)

c:\work\Jor\vol707_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1238-1241

Knowledge, Attitude and Practice of Pharmacists
Regarding Dietary Supplements
Mesfer Safar Almalki1, Attiah Abdullrhman Khobrani1,
Fakhir Thamir Alotaibi1, Hassan Abdullah Aljabri2
1Security Forces Hospital of Makkah, 2Alnahdi Medical Group

Background: Dietary supplement "DS" products are sold in the pharmacies very widely. However, there is no
specific approval or definition to the legal and scientific usage of such products.
We aim in this study to show the level of knowledge of pharmacists concerning the non-
scientifically medically prescribed medication and formulas which is known as "Complementary and
alternative medicines". Also, there is a variety of pharmacist's attitude concerning such treatment methods we
need to evaluate and prove.
Material and methods: Questionnaire form to assess the knowledge and measure the attitude and practice of
those pharmacists by direct meeting for the larger pharmacies and postal distribution for the lesser
Results: Based upon our study in hand, we affirm that there are several elements contributing in forming the
general attitude and practice of pharmacists in treating with Dietary supplements.
Conclusion: knowledge of pharmacists of Dietary supplement (DS) products depends on both educational
and environmental factors which form the knowledge base for them while dealing with customers and patients
Pharmacists, Dietary supplements, DS, CAM, KAP.


gain the knowledge of how to deal with it, and to
It is well known that pharmacists resemble the
define whether this treatment is good or bad (2).
most important interface of the field of medicine.
CAM products are a collection of systems
They are the executive partition of the treatment.
specified for health care. Those systems depend on
The knowledge they gain and apply over the
certain practices, products, and medication which
patients, whether as per the prescription assigned by
are not approved by the higher committees of
doctors or based upon the request of the patients
medicine (2).
themselves, must by any mean be superior to the
It is calculated in 2007 that around forty
level of application. They are supposed to know
percent of adults in US used CAM products and
precisely the goodness and badness of each
practices in a way or another. Also, we found that in
application method for any kind of treatment. It is
Australia in 2003, there was a collection of fifty two
their job to convey certain results based upon the
percent of adults who had used DS, and that
scientific approved method of the high boards and
percentage is increased in 2007 to reach around
committees of medicine (1).
seventy percent. The percentage which is viewed in
One of the main issues pharmacists face in a
Canada for the same statistics was approximately
daily basis is the treatment with dietary supplements
seventy one for the consumption of DS products. As
or what is called complementary and alternative
for the developing countries, there is a huge growth
medicine "CAM". They face ethical and scientific
of the consumption of DS products where the
issues while dealing with such materials and
market of DS reach around sixty five percentage of
substances to be considered as approved medicine in
consumption from their population (3). Since those
the first place (1).
products show no significant side effects on the
Dietary supplement products are sold in the
patients, their market is very wide and grows
pharmacies very widely. However, there is no
rapidly. And here comes the part where pharmacists
specific approval or definition to the legal and
are required to attain the needed knowledge to judge
scientific usage of such products. And since there is
on those products. Patients and consumers are
no certain knowledge base for the treatment with DS
enchanted by the idea that pharmacists have all the
and CAM products, the decision making of this
answers about the usage of DS products, and they
process is taken for granted every time a patient asks
expect from them to recommend certain products
for such products from the side of the pharmacist
and explain their mechanism of action.
selling the product to them (2).
That requires from the pharmacists to take
Since there is a huge consumption of DS and
decisive actions towards those products. So,
CAM products all over the globe, we intend to
pharmacists face many troubles distinguishing the
explain the definition of the term firstly to be able to
knowledge conveyed to the consumers about DS
Received: 19/12/2017 DOI: 10.12816/0044557
Accepted: 29/12/2017

Full Paper (vol.707 paper# 29)

c:\work\Jor\vol707_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (7), Page 1242-1247

Assessment of Knowledge, Awareness, and Behavior of Folic Acid
Use among Females during The Childbearing Period in Tabuk City-2017
Samr Abdullah Alblowi1, Mona Hameed Alomayri1
1 Obstetrics & Gynecology department, King Fahad Specialist Hospital, Tabuk/Saudi Arabia

A balanced diet is very important for pregnant women, which consists of proteins, carbohydrates,
vitamins, minerals and fats. Supplements do not replace a healthy diet but rather ensure that a woman is taking
enough daily nutrients. Folic acid (FA) is a B vitamin, which is found in different foods but can be best got
through a multi-vitamin. Things such as leafy green vegetables, fortified cereals, orange juice and strawberries
are just some of many foods that contain folic acid. Congenital anomalies affect an evaluated 3% of newborns
worldwide. Nearly 50 years ago, it was found that the B-vitamin folic acid play a role in improving normal
embryonic development. This study done to investigate the level of awareness among female college students on
the importance of preconception folic acid supplementation in preventing neural tube defects (NTDs).
Methods: We have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia. A
self-administered questionnaire requires information about Knowledge, awareness, perception of Folic Acid
importance and use among females during the childbearing period, has been filled by participants.
In this study, there was a significant relation between age and if ever heard about folic acid (p<0.001),
and for work and if ever heard about folic acid (p<0.001). Those who heard about folic acid were ninety four,
and the majority of them aged from eighteen to thirty years (65.9%). Among those who heard about folic acid,
the majority were university graduated (73.4%).
We need to apply more efforts to increase the knowledge and emphasize on the importance of the
use of folic acid among females in Tabuk city.
folic acid, awareness, dose, deficiency, complications.

the B-vitamin folic acid plays a role in improving
A balanced diet is very important for pregnant
normal embryonic development(6). For low risk
women. It consists of proteins, carbohydrates,
pregnant, current recommendations from the
vitamins, minerals and fats. It is the best way to
National Institute of Clinical Excellence in the
receive nutrients, but vitamin supplements can also
UK(7), recommends 400 g of FA daily, starting
be beneficial. Pregnant women should only take
before pregnancy, continuing for the first 12 weeks
vitamin supplements on a doctor recommendation.
of pregnancy. In high risk patients, that is, those who
Supplements do not replace a healthy diet but rather
have had a previous child with an NTD, or for
ensure that a woman is taking enough daily
women taking certain anticonvulsants, 4-5 mg is
nutrients. Vitamin supplements work best when
recommended(8). For those at intermediate risk of an
taken as part of a healthy diet and not as a substitute
NTD, including those with type 1 diabetes, epilepsy,
for a healthy diet(1).
obesity, a family history of NTDs, those belonging
Folic Acid is a B vitamin, which is found in
to certain ethnic or religious groups, for example,
different foods but can be best got through a multi-
Sikhs in British, Columbia, and those who do not
vitamin. Things such as leafy green vegetables,
comply with medication or healthy diets, as well as
fortified cereals, orange juice and strawberries are
those who take alcohol, use tobacco or recreational
just some of many foods that contain folic acid.
These foods alone may not contain the entire
Gynecologists in Canada also recommends that 4-5
recommended daily allowance of 400 mcg, since
mg FA should be started 3 months before pregnancy
some of the folate can be reduced through cooking
and continued 10-12 weeks post conception. After
it(2.3.4). A review has been conducted and its main
this, a mother may switch to a lower dose (0.4-1.0
objective was on the saving of folate as folic acid or
mg) for the remaining part of the pregnancy and
5-MTHF (with or without other vitamins and
continue during breastfeeding(9).
minerals) in the periconceptional period (prior to

conception and in early pregnancy, before 12 weeks'
gestation) to reduce the occurrence of neural tube
We have conducted a descriptive cross-
defects (NTDs) and other birth defects(5). Congenital
sectional study in Tabuk city population, Saudi
anomalies affect an evaluated 3% of newborns
Arabia. The study was conducted during the period
worldwide. Nearly 50 years ago, it was found that
from June to November 2017. The participants were
Received: 19/12/2017 DOI: 10.12816/0044558
Accepted: 29/12/2017

Full Paper (vol.707 paper# 30)